摘要
目的评估青少年特发性脊柱侧凸（AIS）椎弓根螺钉不良置人的模式并分析其原因。方法收集从2008年7月至9月行后路椎弓根螺钉固定的70例AIS患者的临床资料，其中男性12例，女性58例；年龄12～19岁，平均（14．5±2．7）岁；术前Cobb角40°～125°，平均62，0°±18．2°。术中根据解剖标志徒手置入椎弓根螺钉，所有患者术后均行CT检查。在PACS系统上通过PacsClient软件测量螺钉穿破椎弓根内、外壁以及椎体前缘的距离。定义穿破任一壁超过2mm为不良置钉。不良置钉中穿破内壁超过4mm或钉尖使主动脉变形定义为高危置钉。对数据进行统计学分析，探讨不良置钉的危险因素。结果共置人椎弓根螺钉1030枚，胸椎773枚，腰椎257枚。不良置钉108枚（10．5％），其中穿破外壁35枚，穿破内壁56枚，穿破椎体前缘33枚（其中有16枚既穿破了椎体前缘又穿破了外壁）。高危置钉16枚（1．6％）。顶椎、顶椎近端第5节段和顶椎远端第4节段的不良置钉率高于其他节段，其中顶椎左侧和顶椎近端第5节段右侧不良置钉率均高于对侧。顶椎区高危置钉率最高，达4．8％。Cobb角〉90°组不良置钉率高于Cobb角40°～90°组，椎体旋转Ⅲ～Ⅳ度组不良置钉率高于椎体旋转0～Ⅱ度组。结论AIS不良置钉集中在顶椎、顶椎近端第5节段和顶椎远端第4节段3个区域，高危置钉多发生在顶椎区，危险因素包括Cobb角大小、旋转程度以及与顶椎的距离。
Objective To evaluate and analyze the misplacement patterns of the pedicle screws in surgical correction of patients with adolescent idiopathic scoliosis. Methods For this study, 70 consecutive cases of patients with adolescent idiopathic scoliosis treated by posterior instrumented spinal fusion with pedicle screws were investigated from July 2008 to September 2008. Postoperative CT scans were performed in all cases. The patients included 58 girls and 12 boys, with a mean age of 14. 5 ±2. 7 years at surgery （range 12- 19 years）. Pediele screws were inserted using anatomic landmark with free hand technique. A number of parameters were measured using PacsClient software （PACS） on workstation, which included distances of the penetration of medial, lateral pedicle cortex and anterior vertebral cortex. The distance between edge of aorta and tip of screw should be measured if left pedicle screw penetrated lateral pedicle cortex or anterior vertebral cortex. Misplacement screws with 〉 2 mm of either pedicular cortex perforation and grievous screws with 〉 4 mm of medial pedicle perforation or contour of aorta were defined. The influencing factors for misplacement screws were analyzed. Results A total of 1030 pedicle screws were inserted, 773 in thoracic pedicle and 257 in lumbar pedicle. There were 108 （10. 5% ） misplacement screws, 35 of which penetrated lateral pedicle cortex, 56 of which penetrated medial pcdicle cortex, 33 of which penetrated vertebral anterior cortex. Misplacement screw rate of apical vertebra, 5 segments above apical vertebra （AV -5s） and 4 segments below apical vertebra （AV ＋ 4s） were higher than other levels. Most of grievous screws were placed in apical vertebra region. Conclusions The risk factors for misplacement screws ineluded Cobb angle 〉 90° and vertebrae rotation extent up to Ⅲ-IV. Care should be exercised during pedicle screw instrumentation in the apical region of the main thoracie curve, AV-5s region and AV ＋ 4s region.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第22期1725-1727,共3页
Chinese Journal of Surgery
