胸腰段短阶段椎弓根螺钉置钉位置不佳原因临床分析

Clinical study on the incorrect implant of short segment pedicle screw instrumentation

目的:分析临床应用胸腰段短阶段椎弓根螺钉出现置钉位置不佳的原因,以提高手术成功率及手术效果.方法:1995年3月～2003年8月行短阶段椎弓根螺钉固定治疗胸腰椎脊柱疾患592例,其中置钉位置不佳22例,通过临床检查、初次手术情况、X线片检查,再次手术情况对置钉位置不佳的原因及对策进行分析.结果:22例置钉位置不佳原因主要包括:(1)解剖不熟悉所致12例:包括正常椎弓根变异;骨折及退变时椎弓根变化而致进钉点掌握不当;(2)手术技术掌握不够所致10例:包括进钉的深度和角度不当.结论:应用短阶段椎弓根螺钉系统治疗胸腰椎疾患手术医师应术前仔细阅X线片,熟悉椎弓根的局部解剖及手术技术.

Objective:To find out the cause of incorrect implant of short segment pedicle screw after spinal internal fixation.Method:Twenty-two cases incorrect implant of pedicle screw were received between March 1995 and August 2003.The reasons of the incorrect implant were noted by physical examination,scrutinizer of operation and X-ray or CT scanning.Result:The reasons accounted for the incorrect implant of the pedicle screw could be classified into two items:(1)unfamiliar with regional anatomy 12 cases,especially in variation of abnormal anatomy,such as fracture,degenerative spondolisthesis.(2)incorrect use of spinal technique 10 cases,including implant the pedicle screws in improper depth and angle.Conclusion:It is essential for spinal surgeons to read X-ray films carefully before operation,know well regional anatomy and correct surgical approaches in order to minimize this complication.