董亮;谭明生;移平;杨峰;唐向盛;

• 1:北京协和医学院研究生院
• 2:中日友好医院脊柱外科

摘要(Abstract)：

[目的]分析评估经寰椎后弓侧块(椎弓根)螺钉固定术置钉过程中利用骨膜下剥离显露法(subperiosteum exposure method,SEM)保护寰椎后弓周围的重要血管和神经的有效性和安全性。[方法]自2009年6月~2013年6月,回顾性分析利用经寰椎椎弓根螺钉固定术治疗寰枢椎脱位患者76例,男47例,女29例;年龄5~64岁,平均40.1岁。寰椎置钉均采用经寰椎椎弓根固定技术,共置入螺钉152枚,置钉过程中,均采用SEM保护寰椎后弓上的椎动脉(vertebral artery,VA)和后弓下方的静脉窦与C2神经根。术后给予X线片、CT评估融合状态。JOA评分评估功能恢复情况。[结果]所有患者均成功完成手术,平均手术时间161 min(90~240 min);平均出血量279 ml(150~450 ml)。置钉过程中无脊髓损伤,无椎动脉出血。静脉窦出血3例,应用明胶海绵压迫后止血,静脉窦出血率为4.0%。其中70例患者获得随访,平均随访时间22.7个月(6~84个月)。随访过程中无C2神经支配区域的枕部麻木或疼痛;无椎动脉损伤的症状和体征;无螺钉松动、移位,平均植骨融合时间4.6个月(3~9个月);JOA评分从术前的(8.83±2.77)分提高到术后的(13.69±3.25)分(P<0.05)。[结论]在经寰椎椎弓根螺钉固定术中,SEM提供了有效可行的保护寰椎后弓上下重要血管和神经的方法,成为寰椎后弓手术操作中重要的辅助技术。

关键词(KeyWords)： 寰椎;椎弓根;骨膜

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 董亮;谭明生;移平;杨峰;唐向盛;

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参考文献(References)：

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