徒手克氏针加叩击法制备胸椎椎弓根钉道置入螺钉的准确性评估  

Kirschner wire technique for pedicle screw insertion in thoracic scoliosis: Accuracy evaluation

作　　者：郝定均[1] 贺宝荣[1] 吴起宁[1] 周劲松[1] 王晓东[1] 刘团江[1] 宋宗让[1] 贺增良[1] 郭华[1] 

机构地区：[1]西安市红十字会医院脊拄科,陕西省西安市710054

出　　处：《中国组织工程研究与临床康复》2008年第26期5019-5022,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：陕西省科技厅社会发展资助项目(2003K10-G26)~~

摘　　要：背景：脊柱侧凸矫正中椎弓根螺钉置入的成败依赖于钉道的制备。目的：以徒手克氏针加叩击法制备胸椎椎弓根钉道,观察螺钉置入的准确性及置入后与宿主的组织相容性反应。设计、时间及地点：回顾性病例分析,于2000-01/2005-01在西安市红会医院脊柱外科进行。对象：采用徒手克氏针加叩击法制备胸椎椎弓根钉道置入椎弓根螺钉的方法矫正胸椎侧凸畸形129例,其中103例获得随访,男42例,女61例;年龄13-19岁,平均15.3岁。方法：咬除进钉点骨皮质,以据术前X射线片、CT片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。达到测定的深度停止进针,球形探子探查无误后改用导锥顺着制造的钉道小心缓慢进入,深度一致后,再次用球形探子探查,置入螺钉。主要观察指标：①术中血管损伤、脑脊液漏以及螺钉位置。②置入螺钉的准确性。③置入后观察冠状面、矢状面和旋转畸形的矫正度。④材料与宿主的生物相容性。结果：①胸椎椎弓根螺钉一次性置入成功为96.2%,32枚螺钉位置不当,其中18枚术中即被发现,偏内侧5枚,偏下方3枚,偏上方4枚,偏外侧6枚,其余的14枚螺钉都是置入后通过CT或者X射线片发现,且均偏外侧。②1例术中脑脊液漏者骨蜡封闭后未发生脑脊液漏。③置入后平均身高增加4.6cm,置入后冠状面Cobb角平均21°,平均矫正率73%;矢状面Cobb角平均23°。旋转畸形矫正Ⅰ-Ⅱ度。平均随访3.5年,最终随访矫正度丢失率为1.8%。④迟发性感染1例,螺钉断裂4例,1例螺钉向椎弓根外侧偏移加重。结论：采用克氏针制备胸椎椎弓根钉道置入螺钉准确率高,并发症少,宿主发生组织相容性的机率较低。BACKGROUND： Insertion of pedicle screws into vertebra thoracalis determines the success of scoliosis correction. OBJECTIVE： To observe the methods and results of screw insertion and histocompatibility of host using Kirschner wire plus tapping technique, DESIGN, TIME AND SETTING： Retrospective case analysis was performed at Department of Spinal Surgery of Xi＇an Red Cross Hospital from January 2000 to January 2005, PARTICIPANTS： 129 cases underwent pedicle screw implantation to correct thoracic scoliosis using Kirschner wire plus tapping technique. 103 patients were followed up, including 42 males and 61 females, with a median age of 15.3 years （range 13 to 19 years）. METHODS： Cortical bone at screw entrance site was removed with rongeur forceps. According to the preoperative depth and rotation measured by radiographs and CT, 1.5 mm and 2.5 mm Kirschner wires were used to drill holes along pedicle until achieving the depth. The hole was detected using specillum followed by awl entrance, After rechecking the hole using specillum. the screws were inserted, MAIN OUTCOME MEASURES： Blood vessel injury, leakage of cerebrospinal fluid and position of screws; accuracy of screws; correction degree on coronal plane, sagittal plane and rotation deformity; biocompatibility of materials to host. RESULTS： 96,2% was successful inserted by one time, There were 32 screws with wrong direction and 18 screws were found during the operation; 5 of screws were medial. 3 were below, 4 were superior, and 6 were lateral; 14 lateral screws were found by CT or X-ray postoperatively, One with leak of cerebrospinal fluid in operation was blocked by bone wax and no leak of cerebrospinal fluid occurred after surgery. There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of incisional wound, Razor back deformity was obvious improved and body height was increased 4.6 cm after surgery, The Cobb angle at coronal plane was 21° after surgery and correction rate was 73%. The Cobb angle in

关 键 词：胸椎 脊柱侧凸 椎弓根螺钉 徒手技术 矫形手术 

分 类 号：R681.5[医药卫生—骨科学]