胸腰椎经皮椎弓根螺钉置钉的准确性分析

Accuracy of percutaneous pedicle screw insertion in thoracic and lumbar spine

中文关键词:  胸椎  腰椎  经皮椎弓根螺钉  置钉准确性

英文关键词:Thoracic spine  Lumbar spine  Percutaneous pedicle screw  Accuracy of screw insertion

中文摘要:

  【摘要】 目的：分析胸腰椎经皮椎弓根螺钉固定术的置钉准确性。方法：回顾分析2010年7月~2012年12月我院53例胸腰椎经皮椎弓根螺钉固定术患者，男31例，女22例；年龄18~73岁，平均51.2岁。腰椎退变性疾病24例，胸腰椎骨折29例。置钉节段为T8~S1。根据术后CT轴位扫描图像以及患者是否出现椎弓根螺钉相关并发症，将椎弓根螺钉位置分级：0级，螺钉位于椎弓根皮质内；1级，螺钉突破椎弓根骨壁但≤2mm；2级，螺钉突破椎弓根骨壁＞2mm，但无神经受压等症状；3级，出现螺钉相关并发症。结果：共置入椎弓根螺钉212枚，平均4.0枚/例。212枚螺钉中，0级175枚（82.5%）；1级32枚（15.1%）；2级4枚（1.9%）；3级1枚（0.5%），患者出现神经受压症状，行翻修术。37枚位置不佳的螺钉中，24枚向内侧切出椎弓根，13枚向外侧切出。结论：胸腰椎经皮椎弓根螺钉固定技术虽置钉位置欠佳率较高，但很少发生2级以上置钉位置不佳者。

英文摘要:

  【Abstract】 Objectives: To analyze the accuracy of percutaneous pedicle screws in thoracic and lumbar spine. Methods: 53 patients treated with percutaneous pedicle screw instrumentation in thoracic and/or lumbar spine were retrospectively analyzed in our hospital from July 2010 to December 2012. The patients aged from 18 to 73 years(average, 51.2 years), there were 31 males and 22 females. Twenty-four patients suffered from degenerative lumbar diseases and the other 29 from spinal fractures. The segments of pedicle screw insertion ranged from T8 to S1. The pedicle screw accuracy was graded by CT axial scans, along with the occurrence of screw-related complications. Grade 0: screw within cortex of pedicle; grade 1: screw thread breach of pedicle wall ≤2mm; grade 2: significant breach >2mm with no neurological compromise; grade 3: screw related complications. Results: Totally 212 screws were inserted, with an average of 4.0 per case. Among all 212 screws, 175(82.5%) were graded into grade 0, 32(15.1%) into grade 1, 4(1.9%) into grade 2. Only one patient with grade 3 in one screw developed neurological compromises and relived after revision surgery. Twenty-four out of the 37 inaccurately placed pedicle screws encroached the pedicle from the medial wall, while 13 from the lateral wall. Conclusions: The inaccuracy rate of percutaneous pedicle screw insertion in thoracic and lumbar spine is relatively high, but inaccurate screws with grade 2 and above rarely occur.