非透视下胸腰椎椎弓根螺钉的植入

Thoracic and lumbar pedicle screw insertion without image intensification

目的探讨非透视下胸腰椎椎弓根螺钉的植入方法、操作技术及应用疗效。方法对220例胸腰椎骨折脱位患者在非透视下植入椎弓根螺钉,行椎弓根钉棒系统内固定,术中根据第12肋骨、骶骨或骨折的横突等标志确定椎体次序。结果220例中有1例出现椎体次序定位错误。在880枚螺钉中,有95枚出现偏入椎间隙、在腰椎与椎体终板夹角>5°、超出椎弓根下缘及内缘、超出椎体前缘等失误,无诱发新的神经损伤症状或脑脊液漏等并发症,螺钉植入准确率88·75%。结论掌握精确的椎弓根解剖知识及熟练的操作技术,术前进行详细的评估,严格按规范操作,无透视监控下椎弓根螺钉的植入是可行的。

Objective To investigate the thoracic and lumbar pedicle screw insertion without image intensification and its effec：. Methods 220 cases with thoracic and lumbar fractures and dislocations were treated with pedicle screw fixation. The pedicle screws were inserted without image intensification. The spinal segments were identified with the marks of 12th rib, sacrum and transverse process, Results 1 case was complicated with segment wrong identification. 95 of 880 pedicle screws were complicated with interbody insertion, 〉 5° endplate-screw angle, inferior and medial pedicle protrusion and anterior vertebral protrusion, No new nerve damage symptom or cerebrospinal fluid leakage was found. The accurate rate of pedicle screw insertion was 88, 75%. Conclusions With mastering accurate pedicle anatomy and skillful manipulation, pedicle screw can be inserted without image intensification.