个体化选择脊柱侧凸患者胸椎椎弓根螺钉进钉点的研究

Individual selection of the entrance point for thoracic pedicles in the surgery of scoliosis

目的:探讨个体化选择脊柱侧凸患者胸椎椎弓根螺钉进钉点对置钉准确性的影响。方法:2006年3月至2008年6月手术治疗脊柱侧凸患者57例,其中青少年特发性脊柱侧凸44例,先天性脊柱侧凸12例,马凡综合征1例。根据患者术前CT设计拟固定胸椎的椎弓根螺钉进钉点并用于指导术中的进钉点选择,术后根据螺钉是否突破椎弓根的皮质壁来判断置钉准确性。结果:全部患者共置入椎弓根螺钉591枚,胸椎417枚,腰椎174枚,术后530枚螺钉的轴线完全位于椎弓根皮质内,准确率为89.7%,其中胸椎置钉准确率为86.8%(362/417)。61枚螺钉的轴线突破椎弓根皮质壁,胸椎55枚,腰椎6枚。55枚偏置的胸椎椎弓根螺钉中52枚螺钉的实际进钉点与术前设计一致,其中19枚钉尖位于椎体内;3枚螺钉为术中实际进钉点选择失误,螺钉轴线突破椎弓根皮质壁的距离均不超过4mm。无脊髓、大血管及脏器损伤等严重并发症发生。结论:个体化选择胸椎椎弓根螺钉进钉点可提高脊柱侧凸患者胸椎置钉的准确率,减少术中进钉点选择失误所致的并发症。

Objective：To study the affect of individual selection of the entrance point for thoracic pedicles on the accuracy of pedicle screws placement in the surgery of scoliosis.Method：57 cases with scoliosis from March 2006 to June 2008 were analyzed retrospectively.The diagnosis including：adolescent idiopathic scoliosis 44 cases,congenital scoliosis 12 cases and MarFan syndrome 1 case.The entrance point of thoracic pedicle in operation was determined with the point designed by surgeons preoperatively on CT.The accuracy of the pedicle screws placed was evaluated by determining the axis of the screw whether penetrated pedicle cortex or not.Result：Of the total 591 pedicle screws inserted（thoracic 417,lumbar 174）,530 screws（89.7%） were fully contained within the cortical boundaries of the pedicle,61 screws（thoracic 55,lumbar 6） were misplaced with the axis of the screw penetrated pedicle cortex.Accuracy rate of thoracic pedical screw placement was 86.8% （362/417）.Among 55 misplaced thoracic pedicle screws,52 pedicles entrance points were the same as designed by surgerons preoperatively, 19 screws with good effect of biological fixation.h was only 3 misplaced pedicle screws because of incorrectly selection of entrance point during sugery ,but the distance of the axis of the screw penetrated the pedicle cortex was not exceeded 4.0mm.There were no spinal cord,great vessels or organ damage occurred.Conclusion：The accuracy in placement of thoracic pedicle screws in the surgery of scoliosis can be improved by individual selection of the entrance point on thoracic pedicles,and the incidence of complications may also be reduced correspondingly by avoiding misplacement of the pedical screws.