个体化骶1椎弓根螺钉置入的初步临床应用

Clinical application of individualized S1 pedicle screw placement

目的探讨个体化模拟骶1椎弓根螺钉最佳置入路径在临床中应用的可行性。方法回顾分析自贡市第四人民医院2017年5月-2019年4月收治的腰椎疾病患者,根据是否采用术前个体化设计骶1椎弓根置钉路径,分为个体化置钉组和传统置钉组。分析比较两组患者螺钉尖部与骶1上终板的距离D,螺钉在失状位平面与腰5椎弓根的夹角α及横断位上螺钉的内倾角度β,所用长度为35、40 mm螺钉数目及随访1年内螺钉的松动率。结果共纳入患者59例,个体化置钉组31例,传统置钉组28例。个体化置钉组在螺钉尖部与骶1上终板的距离D[(2.61±0.82)vs.(4.13±1.51)mm,t=-5.718,P<0.001]、螺钉在失状位平面与腰5椎弓根的夹角α[(9.31±3.52)vs.(13.53±4.78)°,t=-5.646,P<0.001]、螺钉的内倾角度β[(15.73±6.04)vs.(10.65±5.09)°,t=3.022,P=0.004]、使用螺钉型号[长度40 mm螺钉:56 vs. 8枚,长度35 mm螺钉:6 vs. 48枚,χ^2=68.539,P<0.001]和术后随访1年出现螺钉松动率[3.22%vs. 16.07%,χ^2=5.774,P<0.001]上与传统置钉组比较,差异均有统计学意义。结论术前个体化设计骶1椎弓根螺钉的置钉路径能较好地应用于临床,在增加骶1椎弓根螺钉的生物力学稳定性同时也能取得较好的矢状位平衡。

Objective To explore the feasibility of the clinical application of individualized simulated S1 pedicle screw. Methods The data of patients with lumbar disease diagnosed and treated in the Fourth People’s Hospital of Zigong from May 2017 to April 2019 were retrospectively analyzed. According to the preoperative individualized design of the S1 pedicle screw placement path, the patients were divided into individualized screw placement group and traditional screw placement group. The distance D between the screw tip and the endplate of the S1, the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L5, the angle of oblique angle β, the number of screws of35 and 40 mm in length, and the screw loosening rate(followed-up within 1 year) in the two groups were analyzed.Results A total of 59 patients were enrolled in this study, 31 in the individualized screw placement group and 28 in the traditional screw placement group. The differences in the distance D between the screw tip and the endplate of the S1[(2.61±0.82) vs.(4.13±1.51) mm;t=-5.718, P<0.001], the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L5 [(9.31±3.52) vs.(13.53±4.78)°;t=-5.646, P<0.001], the angle of oblique angle β [(15.73±6.04) vs.(10.65±5.09)°;t=3.022, P=0.004], the proportion of using screw models [40 mm in length: 56 vs. 8;35 mm in length: 6 vs.48;χ2=68.539, P<0.001], and the screw loosening rate followed-up within 1 year [3.22% vs. 16.07%;χ2=5.774, P<0.001]were statistically significant between the individualized screw placement group and the traditional screw placement group.Conclusions Preoperative individualized design of the pedicle screw of the S1 pedicle screw can be used in clinical practice. The biomechanical stability of the S1 pedicle screw can be improved and the sagittal balance can be achieved.