腰骶椎框架式经皮椎弓根螺钉置入定位器的研发和应用

Lumbosacral Vertebral Frame Type Percutaneous Pedicle Screw Placement Locator Research and Clinical Application

目的探讨腰骶椎经皮椎弓根螺钉置入定位器的研发和临床应用效果。方法 2012年1月至2014年12月收治的腰椎骨折、腰椎结核患者共50例。其中男性29例,女性21例;年龄28.9~65.3岁,平均37.1岁;腰椎骨折35例,腰椎结核15例。入院后给予骨科常规检查,心、脑、肺、肝、肾功能正常,无高血压、糖尿病、脑卒中等疾病,经患者本人签署知情同意书,自愿采用我科自行研制的腰骶椎经皮椎弓根螺钉置入定位器,并行经皮椎弓根螺钉固定术。结果术前定位时间为（3.25±1.75）min,平均定位次数为1.26次,准确率为98.7%。术中定位时间为（5.46±1.54）min,定位次数为2.58次,准确率为98.8%。随访期间均定期采集患者的腰骶椎正侧位X线片和CT片等影像学资料进行分析,无手术并发症。结论自行研制的腰骶椎框架式经皮椎弓根螺钉置入定位器及定位方法能够简化手术操作,具有小巧精致、方便消毒、放置稳定性好、定位准确性高、定位时间短、透视次数少、医护人员及患者接受X线射线暴露量低等优点,为微创脊柱外科提供了一种体外定位工具,适合在临床推广应用。

Objective To develop a locator of the percutaneous lumbosacral pedicle screw placement,and investigate the clinical effect. Methods From January 2012 to December 2014,50 cases were treated in our department,including 35 patients with lumbar fracture,15 patients with thoracolumbar spinal tuberculosis. There were 29 males and 21 females,with an average age of 37. 1（ ranging 28. 9 to 65. 3） years old. All of them were operated by percutaneous pedicle screw fixation under guiding of the locator developed by ourselves. Before operation,all patients gave their consent to use the facility. All cases were conducted a routine inspection,including heart,brain,lung,liver,kidney function,etc. to verify no diseases such as hypertension,diabetes,stroke etc. Results Before operation the time for location was 3. 25 ± 1. 75 min,and the location times was 1.26 on average,and the accuracy rate was 98. 7%. In operation the time for location was（ 5. 46 ± 1. 54） min,and the location times was 2. 58 on average,and the accuracy rate was 98. 8%. During the follow-up period all patients were examined by X-ray and CT,and collected the positive and lateral X-ray films of lumbosacral vertebral and CT imaging data to analyze. The incidence rate of complications was 0. Conclusion The application of the guide frame for percutaneous placement of lumbosacral pedicle screw and the positioning method can simplify the operation process. The facility is compact,accurate,convenient for disinfecting and stable for placing. It can shorten the positioning time,and reduce X-ray exposure times. As a result,it can decrease the radiation exposure dose of doctors and patients. The study has provided a convenient tool for minimally invasive spinal surgery. It should be apply extensively in clinic.