摘要
目的：观察颈椎椎弓根置钉的准确性,分析螺钉误置的临床特征。方法：32例施行颈椎椎弓根置钉手术患者,男22例,女10例;年龄25-74岁（51.5±13.6岁）。颈椎骨折/脱位16例,颈椎后纵韧带骨化8例,颈椎多节段椎间盘突出1例,颈椎管内肿瘤7例（神经鞘瘤3例,脊膜瘤3例,室管膜瘤1例）。术前进行颈椎CT三维重建,确定椎弓根螺钉的进钉点,并测量椎弓根的内倾角、矢状面角度及直径、长度等参数;术中在C型臂X线机透视辅助下置入椎弓根螺钉;术后复查颈椎CT观察椎弓根螺钉位置,按照Lee等的方法判断椎弓根螺钉位置准确性：0级,螺钉未穿破椎弓根;1级,螺钉穿破椎弓根〈25%的螺钉直径;2级,螺钉穿破椎弓根〉25%,但〈50%的螺钉直径;3级,螺钉穿破椎弓根〉50%的螺钉直径。2级和3级判为螺钉误置,分析椎弓根螺钉误置的特点;观察血管神经损伤等并发症情况。结果：32例患者中因术中置钉困难更改为侧块螺钉3枚,改为寰椎椎板钩1枚,共置入颈椎椎弓根螺钉147枚（上颈椎40枚,中下颈椎107枚）,椎弓根螺钉位置0级53枚,1级67枚,2级17枚（上颈椎2枚,下颈椎15枚）,3级10枚（上颈椎1枚,下颈椎9枚）。椎弓根螺钉总误置率为18.3%（2级＋3级）;外侧壁穿破17枚,下壁5枚,上壁4枚,内侧壁1枚。上颈椎椎弓根螺钉的误置率（7.5%）显著低于中下颈椎（22.4%）（P〈0.05）;椎弓根外侧壁穿破率（11.5%）高于上壁（2.7%）、下壁（3.4%,）及内侧壁（0.7%）（P均〈0.01）。5例患者6枚螺钉术中椎弓根钉道攻丝后活动性出血,予骨蜡封堵及置入螺钉后即止血,无血肿或脑缺血梗死并发症。3例患者术后出现上肢神经根刺激症状,予颈椎制动、神经营养治疗,分别于术后1个月、3个月、4个月好转。结论：颈椎椎弓根螺钉误置率较高,但相关并发症较少;穿破椎弓根外侧壁多于内侧壁、上壁或下壁;中下颈椎椎弓根螺钉的�
Objectives：To evaluate the accuracy of cervical spine pedicle screw（CPS）insertion,and to explore the features of pedicle screw misplacement.Methods：Thirty-two patients stabilized by CPS were included.The cervical disorders included cervical fracture/dislocation（16 cases）,ossification of posterior longitudi-nal ligament（8 cases）,multiple cervical intervertebral disc herniation（1 case）,neurilemoma（3 cases）,spinal meningioma（3 cases）and ependymoma（1 case）.Pre- and post-operative computed tomography（CT）scanning and multiple-planner reconstruction were used to determine the relevant parameters（entry point,the angle,the diameter and the length of pedicle）and accuracy of the CPS insertion.And the accuracy was classified ac-cording to Lee′s classification criterion：grade 0,no perforation; grade 1,perforation less than 25%; grade 2,perforation more than 25% but less than 50%; grade 3,perforation more than 50%.Grade 2 and 3 were re-garded as misplacement.The pedicle screw placement was under the guidance of C-arm fluoroscopy.The fea-tures of screw misplacement were observed.Clinical outcome was assessed in all cases.Results：Among thirty-two patients,three lateral mass screws and one C1 laminar hook were used to replace preoperative planned pedicle screws.One hundred and forty-seven CPS were placed（40 screws in C1-C2,107 screws in C3-C7）,including 53 screws with grade 0,67 screws with grade 1,17 screws with grade 2（2 screws in C1-C2,15 screws in C3-C7）,and 10 screws with grade 3（1 screw in C1-C2,9 screws in C3-C7）.The total mis placement rate was 18.3%（grade 2 and 3,27/147）：17 screws perforated lateral wall,5 screws perforated inferior wall,4 screws perforated superior wall,and 1 screw perforated medial wall.Pedicle screw perforation rate in C1-C2（7.5%,3/40）was statistically less than that in C3-C7（22.4%,24/107）（P〈0.05）.The rate of lateral wall perforation（11.5%）was statistically higher than that of superior wall（2.7%）,inferior wall（3.4%
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2015年第10期887-893,共7页
Chinese Journal of Spine and Spinal Cord
基金
江苏省"333工程"培养基金资助项目
宿迁市科技支撑计划项目(S201414)
关键词
颈椎椎弓根螺钉
误置
并发症
特征
Cervical pedicle screw
Misplacement
Complication
Feature
