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作 者:邱勇[1] 王渭君[1] 王斌[1] 朱泽章[1] 俞杨[1] 钱邦平[1] 马薇薇[1] 朱锋[1]
机构地区:[1]南京大学医学院附属鼓楼医院脊柱外科,210008
出 处:《中华骨科杂志》2006年第11期728-733,共6页Chinese Journal of Orthopaedics
基 金:江苏省医学重点人才培养项目(RC2001001)
摘 要:目的评价特发性胸椎侧凸胸腔镜辅助小切口前路矫形椎体钉置入的安全性及其意义。方法特发性胸椎侧凸行胸腔镜辅助小切口前路CDH-TSRH矫形手术20例,女18例,男2例;年龄平均14.5岁。Lenke分型1A-6例、1AN5例、1BN6例、1CN3例(协和PUMC分型Ⅰa型12例、Ⅱb1型8例),术前胸弯冠状面Cobb角平均44.7°。利用PACS系统在固定节段椎体横断面CT片上测量右侧肋骨头与螺钉中心的距离a、椎管前壁与螺钉后缘距离b、降主动脉后壁与螺钉前缘距离c、螺钉突出对侧皮质的长度d、主动脉与椎体间的距离e、螺钉与双侧肋骨小头连线的角度α。将螺钉尖与主动脉的距离分为三级:距离>1mm为D级,≤1mm为A级,螺钉使主动脉发生变形为C级。在前后位X线片上测量螺钉与椎体中线的成角β。结果20例患者术后平均矫正率为77.7%。共使用椎体钉155枚,134枚(86.5%)获得双皮质固定,123枚(79.4%)螺钉尖距离主动脉>1mm。2枚螺钉进入椎管。置钉安全性在顶椎区和上下端椎区无差异,但与Cobb角相关。所有患者术中、术后及随访期间无血管、神经及内固定并发症。结论特发性胸椎侧凸胸腔镜辅助小切口前路矫形手术具有良好的矫形效果及较高的置钉安全性。术前CT检查可能有助于提高置钉安全性和避免可能发生的血管、神经并发症。Objective To analysis the accuracy of vertebral screw placed through mini-open anterior approach for adolescent idiopathic scoliosis (AIS). Methods 20 patients with AIS treated with mini-open anterior curve correction were selected into this study, with the average age of 14.5 years. There were 6 in Lenke 1A-, 5 in Lenke 1AN, 6 in Lenke 1BN and 3 in Lenke 1CN. The average coronal Cobb angle of the thoracic curve before operation was 44.7°. At each instrumented level, the position of the screw was analyzed on posterior CT scans to determine its proximity to the spinal canal and the aorta, including the distance from the right rib head to the center of the screw (a), the distance from the anterior cortex of the spinal canal to the posterior edge of the screw (b), the distance from the posterior wall of the aorta to the anterior edge of the screw (c), the length of the screw penetrate the left vertebral body cortex (d), distance from the aorta to the closest point of the vertebral body cortex (e) and the angle composed of the line between the left and right rib heads and the central line of the screw (α). The position of each screw relative to the aorta was determined: D, the screw tip was distant from the aorta (〉1 mm); A, the screw tip was adjacent to the aorta (≤ 1 mm); C, the screw tip was felt to be against the aorta and creating contour deformity. The angle composed of the central line of the screw and the central line of vertebral body on posterior X-ray film was also measured. Results The average correction of the main thoracic curve was 77.7% postoperatively. 155 screws were inserted, of which 134 screws (86.5%) had a bicortical purchase. 123 screws (79.4%) were distant from the aorta. Two screws encroached into the spinal canal. There were no significant difference between the proximal screws, the periapical screws and the distal screws. There were no vascular or neurologic complications or instrumentation failure during operation or follow-up. Conclusion
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