全椎弓根螺钉技术治疗特发性脊柱侧凸

All pedicle screws technique applied to the treatment of idiopathic scoliosis

目的:探讨在脊柱侧凸后路矫正术中采用全脊柱椎弓根螺钉技术的疗效。方法:2002年6月至2005年10月,采用全脊柱椎弓根螺钉技术治疗特发性脊柱侧凸56例,男11例,女45例;年龄8～22岁。侧凸程度按Cobb测量法评估,Cobb角45°～85°,平均62.45°。侧凸按Lenke分型:1型29例,2型6例,3型8例,4型2例,5型8例,6型3例。结果:平均手术时间3h20min,平均出血600ml,T1-L4共置椎弓根螺钉425枚,其中腰椎弓根螺钉181枚,胸椎椎弓根螺钉244枚。术后所有患者均经CT扫描检查,结果发现腰椎弓根螺钉全部准确置入,244枚胸椎椎弓根螺钉中116枚完全通过椎弓根进入椎体,119枚通过肋骨横突复合结构进入椎体,9枚穿破椎弓根内侧壁,置钉准确率96.8%,术中术后均未出现神经血管并发症。手术切口除2例浅表感染,均I期愈合。全部患者均获随访,时间5～40个月,平均22.5个月,术后均无疼痛,X线正侧位及动态位片未见内固定松动断裂及假关节形成。术后Cobb角平均18°,平均矫正44°,矫正率72.5%。所有患者均在4～8个月内恢复正常的生活、学习和工作状态。结论:脊柱侧凸后路矫正术中采用全脊柱椎弓根螺钉技术是一种安全、有效的方法,能取得较好的矫正效果及较少的并发症。熟悉解剖并结合CT扫描,术前进行准确测量及术中的仔细操作对手术成功非常重要。

Objective： To Analyze the therapeutic efficacy of all pedicle screws technique applied to the treatment of idiopathic scoliosis and evaluate its safety. Methods：From June 2002 to October 2005,56 patients with idiopathic scoliosis were treated with all pedicle screws technique, including 11 males and 45 females, ranging in age from 8 to 22 years. According to Lenke classification, 29 patients were Type 1,6 patients were Type 2,8 patients were Type 3,2 patients were Type 4,8 patients were Type 5, and 3 patients were Type 6. Cobb angles ranged from 45°to 85° （mean 62,45°）. Results ：The mean operation time was 3 hours and 20 minutes, and the average amount of bleeding was 600 ml. There were 425 pedicle screws inserted including 244 in thoracic,and 181 in lumbar,the positions of which were evaluated by CT. Nine screws were inserted with perforating through the medial wall of the pedicles. All the patients were followed up for 5 to 40 months （mean 22.5 months）. The mean Cobb angle was corrected from 62 degrees preoperatively to 18 degrees postoperatively, and the average correction rate was 72.5%. No spinal nerves injury was found after operation,and superficial infection occurred in 2 patients but recovered after dressing change. All the patients got satisfactory spinal fusion and remained partly spinal mobility with fewer complications. Conclusion：The application of all pedicles screws technique with familar with pedicular anatomy of scoliosis by imaging ex- amination could gain a satisfactory effect of correction with less complications.