椎弓根钉固定在10岁以下小儿胸腰椎疾患治疗中的应用

Application of pedicle screw fixation in children of below ten years-old with thoracal and lumbar diseases

目的:探讨10岁以下小儿胸腰椎椎弓根钉固定的可行性及安全性。方法:对19例平均年龄6.5岁的胸腰椎疾患患儿,2例骨折脱位患者采用后路短节段椎弓根钉复位固定;3例肿瘤患者采用后路切除肿瘤、短节段椎弓根钉固定;10例先天性半椎体患者采用后路半椎体切除、椎弓根钉矫形固定或前后联合手术;4例脊柱侧凸患者采用后路椎弓根钉矫形固定。椎弓根钉置入点及方向与成人相似,螺钉直径为拟固定椎弓根横径的80%￣90%,长度达椎体的70%￣80%。手术后观察各螺钉位置,随访观察内固定稳定性及神经功能情况。结果:共置入83枚椎弓根钉,术中3个椎弓根破裂造成矫形时螺钉松动,均上移或下移一个节段完成固定;术后检查3枚螺钉位置不良,因未造成神经损害,对固定的稳定性无影响,未做处理。无脊髓神经和血管损伤及感染。18例获得平均24个月随访,1例术后1年螺钉断裂进行了翻修,其余患者无内固定松动。3例术前有神经功能障碍的患者均有明显恢复。结论:在详细的术前计划,选择恰当直径的椎弓根钉、精湛的外科技术下行小儿胸腰椎椎弓根螺钉固定是安全可行的。

Objective：To investigate the effect and security of pedicle screw fixation in thoracal and lumbar vertebra on children below ten years old.Method：There were 8 male and 11 female with average age of 6.5 years.Two cases with paraplegia resulted from thoracolumbar fractures and dislocations were reduced and fixed by short segmental instrument posteriorly.Three cases with tumors were managed posteriorly by resection of tumors and pedicle screw fixation.Ten cases with congenital hemivertebra were treated with resection of hemivertebra and pedicle screw fixation by combined posterior and anterior approachs.Four cases with scoliosis were managed with correction and fixation with pedicle screws posteriorly.The anchoring point and orientation of pedicle screw were similar to that of adult＇s.The diameter of pedicle screws were 80%～90% of the transverse diameters of targeting pedicles and the length was 70%～80% of vertebral body.The positions of pedicle srews were observed radiographically and the stability of spine column and neurological status were dated during routine follow-up.Result：A total of 83 pedicle screws were implanted.Three pedicle screws were observed loosening intraoperatively because of the penetration of pedicles and needed to be adjusted.Three screws were in malposition and not managed because they did not caused neurological deficit and affected the stability.There were no case of spinal cord or vessel injury and infection.18 cases were followed-up for an average of 24 months,all cases except one had satisfied outcome and solid fusion were noted.One patient with thoracolumbar fracture and dislocation had revison surgery because of breakage of screw after one year postoperatively.Three cases with neural deficit recovered remarkably.Conclusion：With detailed preoperative plan,selection of appropriate pedicle screw,and careful surgical technique,it is safe and feasible to perform thoracal and lumbar pedicle screw placement in children below ten years old.