以腰椎峡部裂快速定位椎弓根螺钉的进钉位置

Rapid positioning of pedicle screws through lumbar spondylolysis

背景:目前腰椎峡部裂引起滑脱的患者术中由于峡部裂,腰椎移位明显,局部解剖结构发生改变,给椎弓根定位造成困难,因此有必要找到新的定位方法来解决。目的:通过腰椎峡部裂快速定位椎弓根螺钉位置,减少术中软组织显露,减少手术时间和出血量。方法:通过解剖影像学正侧位测量,分析峡部裂部位与椎弓根中心的位置关系,以椎弓根中心向峡部裂作一垂线,测量L4及L5根弓根中心与峡部裂的距离。选择40例峡部裂伴腰椎滑脱患者,根据峡部裂来定位椎弓根螺钉,记录手术时间、手术出血量及置钉准确率,并与既往传统的AO置钉法对比分析。结果与结论:L4及L5椎弓根中心与峡部裂的平均距离为(8.2±3.6)mm。利用腰椎峡部裂快速定位椎弓根螺钉位置,可减少术中软组织显露,减少手术时间和出血量,置钉过程中及置钉后未发现神经根损伤表现。

BACKGROUND： It is difficult to locate pedicle in the patient with spondylolisthesis induced by lumbar spondylolysis because of spondylolysis, transposition of lumbar vertebrae and alteration of local anatomy. So it is necessary to find a new located method to locate pedicle. OBJECTIVE： To rapid positioning of pedicle screw position through lumbar spondylolysis in order to reduce exposure of soft tissue, blood loss and operation time. METHODS： Position relationship between the spondylolysis and the center of pedicle was analyzed and measured by anterior-posterior film. The distance of the center of pedicle to lumbar spondylolysis （L4, L5） was measured. Forty patients with spondylolisthesis were treated with rapid positioning of pedicle screw through lumbar spondylolysis. Operation time, blood loss and accuracy rate of locate pedicle were recorded and then a comparison of them was made between the AO method and new method. RESULTS AND CONCLUSION： Distance of the center of pedicle to lumbar spondylolysis was （8.2±3.6） mm. Rapid positioning of pedicle screw position through lumbar spondylolysis can reduce the exposure of soft tissue, blood loss and operation time without nerve lesion during and after pedicle screw implantation.