骶2椎弓根螺钉固定在腰骶部稳定性重建中的临床应用

S2 pedicle screw placement for lumbosacral reconstruction

中文关键词:  骶2  椎弓根螺钉  稳定性  临床疗效

英文关键词:Sacrum 2  Pedicle  Stability  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨S2椎弓根螺钉固定在腰骶部稳定性重建中的作用及安全性。方法：13例腰骶椎病变患者，男10例，女3例，年龄40～56岁，平均48.3岁，病程为1d～8个月。骶椎腰化并S1前滑脱2例，其中1例左小腿后侧痛觉减退，另1例无神经功能障碍。L4～Ｌ5椎体结核3例，无神经功能障碍。腰骶部骨折和/或伴侧方移位8例，术前ASIA伤残分级B级3例，C级2例，D级3例。所有患者采用作者设计的S2椎弓根前内侧置钉方法联合其他椎体椎弓根螺钉置入内固定及植骨融合，随访观察患者临床症状、体征、植骨融合情况及内固定位置。结果：所有患者术后随访１年以上，骶椎腰化并前脱位患者复位良好，术后2周活动时疼痛感消失；小腿感觉障碍者术后2周恢复正常。腰椎结核患者术后疼痛减轻，术后1个月内发热均消失，植骨融合良好。腰骶部骨折患者骨折复位良好，ASIA伤残分级随访1年时均提高1级以上。术后１年时随访所有病例双侧S2椎弓根螺钉置入位置良好，固定确实，无手术切口感染及内固定物松动，植骨愈合满意。结论：S2椎弓根螺钉固定应用脊柱外科腰骶部稳定性重建方面具有良好的临床效果及安全性。

英文摘要:

  【Abstract】 Objective：To investigate the S2 pedicle screw placement for lumbosacral reconstruction.Method：13 patients suffering lumbosacral disorders underwent S2 pedicle screw placement．There were 10 males and 3 females with an average age of 48.3 years（range，40 to 56 years）．The course ranged from 1 day to 8 months.2 cases were complicated with S1 lumbarization and spondylolisthesis，of these，1 case had neurological deficit of L5.3 cases were complicated with L4-5 tuberculosis，all showed normal neurofunction．Lumbosacral fractures and/or with the lateral displacement were noted in 8 cases.Preoperative ASIA grade showed 3 level B，2 level C and 3 level D.All patients underwent S2 pedicle screw placement combined with bone graft fusion.The clinical outcome of all patients was reviewed retrospectively.Result：All patients were followed-up for at least 1 year.Patients with S1 lumbarization and spondylolisthesis had good reduction and had pain and paresthesis relieved 2 weeks later.Patients with lumbar tuberculosis had pain relieved after operation and body temperature recovered to normal.Patients with lumbosacral fracture achieved good reduction and had ASIA score increase one level 1 year later.No S2 pedicle screw malposition and instrument failure were noted and all cases had bony fusion finally.Conclusion：S2 pedicle screw placement for lumbosacral reconstruction is safe and reliable.