Cervical-Pillow Fusion Internal Fixation

In recent years, with the continuous development of internal fixation technology, the internal fixation system of the posterior neck pillow has been continuously improved. The correct selection of internal fixation for bone grafting has many benefits for postoperative recovery, and allows postoperative MRI examination. Commonly used in clinical practice are the Cervifix system and the Summit system. Treatment of diseases: cervical spine fracture and dislocation Indication Neck pillow fusion internal fixation is applicable to: 1, sacral, axial fracture, atlantoaxial ligament injury caused by instability of the upper neck, unable to reset or reset is not ideal. 2, sputum, pivotal tuberculosis lesions after removal or stable lesions, but with cervical instability. 3, the upper cervical tumor after anterior tumor resection, or benign lesions need to be stable. 4, rheumatoid cervical spondylosis caused by instability or dislocation of the cervical spine. 5, occipital neck developmental malformation with instability, with or without spinal cord compression. It should be emphasized that the destruction of the anterior column of the spine caused by tumor, fracture and infection causes the cervical vertebrae and the upper thoracic vertebrae to be extremely unstable. It is not enough to rely solely on Cervifix fixation, and the anterior reconstruction must be performed at the same time. Contraindications 1, poor general condition, malignant tumor with multiple organ dysfunction, can not tolerate the operator. 2, local inflammation. Preoperative preparation 1. Skull traction. For the upper cervical spine with trauma, tumor or deformity accompanied by obvious dislocation and severe spinal cord compression, the skull traction can be used to try to reduce the spinal cord compression and help the intraoperative and postoperative braking. However, for the dislocation of the occipital joint, it is not possible to pull, and Halo-Vest brake should be used. 2, prefabricated head and abdomen and head and back two plaster beds, and adaptive training before surgery, in order to facilitate postoperative care. Surgical procedure 1. Reveal From the upper of the occipital trochanter 2.0cm to the neck 4 for the posterior median straight incision, in turn cut the skin, subcutaneous. When exposed, the occipital part should be exposed from top to bottom and the 2~3 lamina of the neck should be exposed from the bottom up, and the two will show the posterior arch of the sacral vertebrae. After the occipital muscle was exposed to the occipital muscle, the occipital muscle was cut along the periosteum and the occipital muscle was cut off to the sides, 2.0 cm on both sides, and the upper edge of the occipital foramen. Identify the 2~3 spinous processes on the side of the spinous process, cut the attachment of the ligament, sarcolemma and posterior cervical muscles. Determine the lamina by finger exploration and then perform subperiosteal along the spinous process and lamina by periosteal stripper. Peel off, dry gauze strips to stop bleeding. The vertebral vertebral vertebral attachment muscles were cut and peeled off, and the occipital and neck muscles were retracted by an automatic hook. 2, treatment of the neck 1 ~ 2 vertebral body If necessary, in the X-ray fluoroscopy, the neck 1~2 dislocation is reset and the Magerl method is used to drill the two-sided neck 1~2 joint screw holes. In order to temporarily stabilize the necks 1 to 2, the drill bit can be temporarily left in one side of the borehole, and then the other drill bit can be drilled with the other drill bit. Drilling is performed under the supervision of a lateral C-arm X-ray machine using a 2.5 mm drill bit. The insertion point is located at the inner edge of the lower 2 joint of the neck 2 to the front side of the head 2 to 3 mm, the drill bit is facing forward in the sagittal direction, the front and rear positions are toward the inner side of the isthmus, and the lateral position is on the posterior edge of the anterior arch of the atlas. The cortex of the side block of the neck. The most suitable bit direction can be determined based on the perspective of the C-arm X-ray machine. The neck 2 screw can also be used as the standard insertion method of the neck 2 screw, that is, the neck 1 to 2 is inserted through the joint screw, but only the neck 2 is penetrated during the drilling and tapping without penetrating the neck 1 to 2 joint. 3. Treatment of the most vertebral body and intermediate vertebral body In the lower cervical vertebra, the joint side block was drilled according to the Magerl method, and the screw entry point was 2 mm from the center side of the side block. The screw is placed in a direction inclined to the head end by 30° to 40° in parallel with the adjacent articular joint and inclined outward by 20° to 30°. The direction of the borehole is aimed at the upper anterior outer side of the superior articular process. In order to screw the screws correctly, a thin nerve stripper can be inserted between the facets to confirm the joint space. Proper placement of the screws minimizes the possibility of vertebral artery and nerve root damage and provides the longest possible screw for optimal fixation. Once the needle point is determined, drill the hole with a 2.5mm drill bit and adjust the length to the initial length of the drill sleeve. Set the maximum drilling depth to 14mm. After drilling the set length, increase the length of the drill sleeve by 2mm each time until drilling. Through the contralateral cortex. 4, temporary installation clip Install all the required retaining clips one by one on the pillow neck fixing rod and tighten them slightly. The length of the neck 1~2 transarticular screw was measured by the neck 1~2 fixed clip, and the neck 1~2 joint was tapped with a 3.5mm tap. The front cortex of the atlas was not required to be broken. The selection of the screw was short and not long. . The same method can also be placed into the neck 2 screw and the neck 2 pedicle screw. 5. Insert the pillow screw The optimal position of the occipital screw to obtain a strong fixation is located in the midline of the cranial line, and the cortical bone outside the midline is gradually thinned. In order to avoid damage to the intracranial venous sinus, the screw cannot be placed above or outside the occipital protuberance. Avoid damage to the cerebellum when drilling and screwing in the screws. It is not uncommon for the dural rupture to cause cerebrospinal fluid leakage. The treatment method is to screw the screw into the borehole, or you can choose bone wax to seal. Drill a hole with a 2.5 mm diameter drill bit under the guidance of a length adjustable drill sleeve initially set to 8 mm. After drilling to the set length, increase the length of the drill sleeve by 2 mm each time until the contralateral cortex is drilled. After drilling through the contralateral cortex, the length of the screw is measured through a screw hole in the occipital neck fixation rod. Use the above method to drill 3 screw holes through the screw hole position on the pillow neck fixing rod, measure the depth, tap and screw the screw. 6, insert the end side block screws The depth of the clamp is measured by the clamp, and the end block screw is screwed into the end. 7, insert the middle screw Adjust the position of the corresponding fixing clip between the neck 2 and the end fixing clip. Insert the side block screws after the same method of sounding and tapping, and finally tighten the fastening screws of the fixing clip. 8, bone graft Bone grafting on the lamina and joint side blocks of the cortical bone. A cancellous bone block with cortical bone is placed between the occipital and cervical spinous processes to support it. complication 1, cervical spinal cord or medullary injury Due to the instability of the atlantoaxial axis, the operation is caused by impact, crushing or shock. This part is deep and must be observed and anatomically based on the characteristics of the lesion to prevent blind cutting and untargeted peeling. Once cervical spinal cord injury occurs, it can cause paralysis and respiratory failure, and death. 2, bone graft does not heal It occurs mostly at the proximal end of the bone graft because the occipital bone bed lacks the cancellous bone surface or is too little contact with the bone graft to cause it to heal.