椎弓根螺钉系统内固定矫正特发性脊柱侧凸

Pedical screws Internal Fixation in correction idiopathic scoliosis

目的:探讨椎弓根螺钉的植入方法,总结钉棒系统矫正脊柱侧凸的效果。方法:咬除进钉点骨皮质,以据术前测量的深度和旋转的程度,分别先后用1.5mm、2.5mm克氏针沿椎弓根方向钻孔,如阻力加大、克氏针弯曲,说明遇到骨皮质,调整进针方向。达到测定的深度停止进针,球形探子探查无误后改用锤子将导锥顺着制造的钉道小心缓慢击入,深度一致后,再次用球形探子探查,植入螺钉。结果:椎弓根螺钉一次性植入成功率:胸段97%(600/619),腰段99%(633/640)。术后未出现脊髓损伤和神经功能障碍,无切口感染。术后冠状面平均矫正率73%。矢状面后凸Cobb’s角(T1～T12)6°～30°,平均23°。旋转畸形矫正Ⅰ～Ⅱ度。139例平均随访4.9年,躯干平衡良好,无平背畸形,植骨融合良好,末次随访冠状面角度丢失率平均为3.7%,迟发性感染1例,螺钉断裂2例,均行内固定取出。结论:克氏针制备螺钉钉道,是椎弓根螺钉植入的较好方法。钉棒结构具有良好的三维矫正控制力。椎弓根螺钉系统内固定矫正特发性脊柱侧凸效果良好。

Objective To discuss the methods of insertion the pedicle screws and sum the results of correction of idiopathic scoliosis.Method Bone of entrance was removed with rongeur forceps.According to the depth and rotation preoperative,to drill using 1.5 mm and 2.5 mm Kirschner wire.If the resistance was increasing and Kirschner wire was bending,it needs to adjust the direction.Stop to drill whenachieve the depth,after checking the hole using special probe then strike awl in the hole.Checking the hole using specillum again then insert the screws.Result 97% were successful inserted by one time.There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of incisionsl wound.The correction rate in coronal plane was 73% after surgery.The Cobb's angle in sagittal plane was from 6° to 30°,with average of 23°.Rotation deformity was corrected Ⅰ to Ⅱ degree.There were 139 patients.Follow up duration was with average 4.9 years.Trunk balance was good and no flat back was happen.Bone graft fused well.The correction lost 3.7% in coronal plane at fi nal follow up.One case was with late infection and 2 patients were with screws broken.The internal fi xations were removed out.Conclusion Using Kirschner wire to made screw hole is a good way to insert thoracic vertebrace pedicle screw.Screw rod system had favourable three diamensions correct control force.Fully pedicle screw to correct idiopathic scoliosis has good results.