“漏斗技术”置入胸椎椎弓根螺钉在青少年特发性脊柱侧弯矫形术中的应用

Clinical application of thoracic pedicle screw placement in adolescent idiopathic scoliosis using funnel technique

目的:探讨应用"漏斗技术"置入胸椎椎弓根螺钉,在青少年特发性脊柱侧弯(Adolescent idiopathic scoliosis,AIS)矫形手术中的实用性和安全性。方法:采用21例AIS,在手术矫形过程中,胸椎椎弓根螺钉的置入均采用"漏斗技术",记录置入操作和术后并发症;对术中确信度不高的胸椎椎弓根置钉行三维C臂(3D-C-arm)断层扫描,观察螺钉在椎弓根的位置,记录穿出骨皮质螺钉的数目及距离;术后早期均行X线摄片判断置入螺钉位置。结果:采用"漏斗技术"置入胸椎椎弓根螺钉268枚,术中三维C臂断层扫描确信度不高的39枚螺钉,无1枚穿透椎弓根内、外侧壁;3枚螺钉(7.69%)穿透椎体前壁,穿透距离<3mm。所有病例术后行X线摄片,观察发现椎弓根钉位置良好;术中及术后未出现血管、神经、脑脊液漏等并发症。结论:在AIS矫正术中,应用"漏斗技术"置入胸椎椎弓根螺钉的方法是实用的、安全的。

Objective：To discuss the practical applicability and security of the thoracic pedicle screw placement by using the funnel technique for the surgery of Adolescent idiopathic scoliosis（AIS）.Methods：The operations of inserting thoracic pedicle screws by using the funnel technique were performed on 21 patients with AIS.Placement process and perioperative complications were rviewed.Low accuracy screws implantation were scaned by 3D-C-arm X ray intraoperatively to determine the screw position corial perforation number and distance.The position of screw placement was evaluated with X-ray in all patients at early stage.Results：A total of 268 thoracic pedicle screws were inserted by the funnel technique,39 screws of low accuracy placement screws were scaned by 3D-C-arm in which none to penetrate the medialis or lateral cortical wall of the pedicles and 3 screws（7.69%） violated the vertebral anterior wall.All patients were observed by X-ray picture after the operation and the positions of the pedicle screws were satisfactory,No neurovascular complications or cerebrospinal leakage were found.Conclusion：The method of thoracic pedicle screws placement by the funnel technique is safe and applicable.