胸腰椎椎弓根螺钉误置的原因分析及对策

Causes for pedicle screw misplacement in the thoracolumbar spine and countermeasures

目的探讨胸腰椎椎弓根螺钉误置的原因及对策。方法1996～2002年对293例脊柱疾病患者施行椎弓根螺钉内固定术发生的螺钉误置情况进行回顾性总结、分析。结果293例共置入椎弓根螺钉1256枚,螺钉植入节段错误7例,占2.38%;上胸椎(T2-7)置钉113枚,有11枚螺钉穿破椎弓根皮质,占9.74%;下胸椎(T8-12)置钉261枚,有9枚螺钉穿破椎弓根皮质,占3.45%;腰骶椎置钉882枚,有16枚穿破椎弓根皮质,占1.81%,共计36枚螺钉,占2.87%;螺钉角异常65枚,占5.81%。结论椎弓根螺钉误置与操作技术、解剖学变异及脊柱病损因素密切相关;良好的手术技巧、术前影像资料的认真观测及术中必要的影像监控是准确置钉的关键。

Objective To discuss the causes for pedicle screw misplacement in thoracolumbar spine and corresponding countermeasures. Methods A retrospective study was done to analyze misplacement of pedicel screw in 293 patients with various spinal disorders who underwent pedicle screw fixation. Results 1256 screws were inserted into thoracolumbar pedicles in the 293 cases, of whom the spinal segmental location error occurred in 7 cases (2.38%). Of the 113 (9.74%) screws in T2 7, 11 penetrated the pedicle cortex; of the 261 screws in T8 12, 9 (3.45%) did; of the 882 screws in L1～S1, 16 (1.81%) did. On the whole, of the total 1256 screws, 36 (2.87%) penetrated the cortex, and 65 (5.81%) had abnormal angle. Conclusions The causes for screw misplacement are poor surgical skills, anatomic variation in vertebrae and spine disorders. The key factors in precise insertion of pedicle screws are fine operative skills, careful study of preoperative spinal image data and the intra operative monitoring.