枢椎椎板螺钉在儿童颅颈交界区手术中使用的临床疗效

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摘要目的探讨枢椎(C₂)椎板螺钉在儿童颅颈交界区手术中使用的临床疗效。方法回顾性分析2009年9月至2016年8月在我院采用C₂椎板螺钉治疗的12例儿童颅颈交界区患者资料，其中男8例，女4例；年龄2～14岁，平均8.2岁。临床症状主要表现为枕颈部疼痛、肢体无力、麻木等，8例患儿有高位颈脊髓病表现。术前行颈椎正侧位和过伸过屈位X线、寰枢椎薄层CT、颈椎MRI和椎动脉CTA检查。采用日本矫形外科学会的(Japanese orthopaedic association scores，JOA)评分系统评价手术前后脊髓功能改善情况，术前平均为13.3分。结果本组12例患者均获随访，随访时间6～20个月，平均10个月；寰枢椎固定7例，枕颈固定5例。7例C₂采用了双侧椎板钉，5例为单侧椎板钉和对侧椎弓根钉。术前存在神经功能损害的8例患者有2例遗留右手握力下降(肌力4级)，1例遗留左上肢灵活性下降，其余完全恢复。末次随访的JOA评分平均为15.8分。结论在C₂椎弓根不适合置钉的儿童患者中，使用C₂椎板螺钉固定的近期疗效肯定。

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	朱昌荣
	王建华
	马向阳
	夏虹 *

关键词 ：枢椎椎板螺钉, 颅颈交界区, 儿童

Abstract：

Objective To investigate the clinical effects of using axial laminar screw in the operation of craniocervical junction in pediatric population.Methods From September 2009 to August 2016，12 pediatric patients who underwent axial laminar screwwere retrospectively analyzed.There were 8males and 4 females with an average age of 8.2 years old(range 2～14).The main manifestations were neck pain，limb weakness and numbness.8 cases hadupper cervical myelopathy.Preoperative imaging examination was performed to clear the spinal cordinjury and vertebral artery variability.The spinal cord function was evaluated by JOA scoring system.The average of preoperative JOA score was 13.3.Results All the 12 cases were followed up for 6 to 20 months (mean 10 months).Atlantoaxialfixation was performed in 7 cases and occipital cervical fixation in 5 cases.Among them，7 cases were treated with bilateral laminar screw and 5 cases with unilateral pedicle screw combined with pedicle screw fixation.No spinal nerve or vertebral artery injury was found.All cases had bony fusion.All 8 patients with preoperative neurological impairment had all the sensory abnormalities recovered，6 patients had normal muscle strength after operation，2 left hand grip strength decreased (grade 4)，and 1 left lower limb flexibility decreased.The JOA score at the last follow-up was 15.8.Conclusion In pediatric patients who are not suitable for pedicle screw placement，the short-term curative effect of laminar screw fixation is reliable.

Key words： axial laminar screw cranial-cervical junction pediatric

基金资助:广东省医学科学技术研究基金项目(A2019072)

通讯作者: 夏虹

作者简介: 朱昌荣(1987－ )，男，主治医师，南部战区总医院骨科医院，510010。

引用本文:

朱昌荣，王建华，马向阳，夏虹 *. 枢椎椎板螺钉在儿童颅颈交界区手术中使用的临床疗效[J]. 实用骨科杂志, 2019, 25(7): 577-587.
Zhu Changrong，Wang Jianhua，Ma Xiangyang，et al. Clinical Efficacy of C₂ Laminar Screw in Children's Cranial-cervical Junction Surgery. sygkzz, 2019, 25(7): 577-587.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I7/577

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