漏斗技术结合徒手椎弓根探针技术在椎弓根置钉术中的应用

Application of funnel and probe techniques of pedicle of vertebral arch only by hand in nail operation

目的探讨利用漏斗技术结合徒手椎弓根探针技术置人椎弓根钉的安全性及准确性。方法术前测量目标椎的e角、f角及椎弓根直径，选择准确的进针点：骶椎以下关节突左7点右5点为进针点，腰椎以人字嵴顶点作为进针点，胸椎按Kim推荐的人点进针。在椎弓根人口去皮质后据e、f角徒手推进椎弓根探针至椎体前缘，测量所需螺钉长度．再沿钉道扩孔、攻丝及置人相应直径与长度的螺钉；术后CT片按照椎弓根内侧壁穿透〈2mm。外侧壁穿透〈4mm作为安全评价标准。回顾性分析自2009年6月～2012年1月利用该技术在184例中置人736枚椎弓根钉的情况。结果所有螺钉椎弓根内侧壁穿透〈2mm，外侧壁穿透〈4mm，总合格率100％；无一例出现神经根或脊髓损伤加重的表现，无一例出现脑脊液漏。结论利用合理的进针点，在个体化置钉的基础上，利用漏斗技术结合徒手椎弓根探针技术能成功置人胸腰椎椎弓根钉。

Objective To investigate the safety and accuracy of insertion pedicle of vertebral arch nail by funnel and probe techniques of pedicle of vertebral arch only by hand. Methods Before operation, e and f angle of the target vertebra was measured and the diameter pedicle of vertebral arch, accurate needling insertion point was selected： left 7 and right 5 were seected as the needling insertion point while articular process that inferior sacrales vertebrae needed operation, crista lambdoidalis while lumbar, the enter-point that recommended by Kim while thoracic vertebra. According to e and f angle after decorticated at the entrance of the pedicle of vertebral arch, the probe of the pedicle of vertebral arch was pushed to the anterior border of the vertebral body only by hand, the diameter and length of needed nail were measured, correspondingly, the hole was expanded along the nail passageway, thread was tapped and bolt was inserted as needed ; After operation, perforation 〈2 nun or 〈4 mm in the medial wall or lateral wall of the pedicle of vertebral arch were selected as the standard safety evaluation, according to CT Photograph. 184 cases with inserted 736 pedicle screws. Results All perforation of the bolt were 〈2 mm or 〈4 mm in the medial wall or lateral wall of the pedicle of vertebral arch, 100 percentage qualified; No case appeared bad manifestations that the injured of the nerve root or spinal cord or cerebrospinal leak. Conclusion Utilizing reasonable needling insertion point, based on individuation nailed nail, pedicle screw of thoracolumbar vertebra can be successfully inserted through funnel combine probe techniques of pedicle of vertebral arch only by hand.