胸椎横突基底作为椎弓根螺钉置入点的临床应用分析  

Clinical application of thoracic transverse process using as the position for thoracic pedicle screw implantation

作　　者：校佰平[1] 李明[1] 徐荣明[1] 胡勇[1] 

机构地区：[1]宁波市第六医院骨科,浙江宁波315040

出　　处：《中国骨伤》2009年第6期454-455,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨胸椎横突基底作为椎弓根螺钉置入点解剖及临床应用价值。方法:132例患者采用胸椎横突基底作为椎弓根螺钉置入点的方法置入椎弓根螺钉,记录术中解剖观察及定位操作方法,观察术后患者并发症的发生情况。患者年龄12～77岁,平均(32±9)岁;其中男84例,女48例。胸椎骨折85例,胸椎退变性疾病27例,脊柱结核12例,脊柱肿瘤8例。结果:所有椎弓根螺钉均徒手置入,共计螺钉788枚。以下胸段(T10-T12)置入螺钉最多为366枚,最少为T14枚。术中未发现大出血及脑脊液流出,未发现漏气。有13个椎弓根术中探查不良而予以及时改正,重新置钉。术后有2例诉有肋间麻木,经过2个月治疗后均消失,未再发现其他并发症。结论:胸椎横突基底作为椎弓根螺钉置入点是一个较为可靠的临床应用技术,从解剖形态学的特点上解决了胸椎椎弓根螺钉进钉点确定难的问题。结合术前的X线片、CT、MRI等影像学检查结果,仔细操作,可以准确、安全、可靠地置入胸椎椎弓根螺钉。Objective：To investigate the anatomy and clinical application of thoracic transverse process using as the position for thoracic pedicle screw implantation. Methods：A total of 132 patients were subjected to thoracic pedicle screws fixation and the pedicle screws implantation position was the basis of transverse process. The data of anatomy, operation method for position and their periopereative complications were reviewed. There were 84 male and 48 female with their age ranging from 12 to 77 years,with an average of 32±9 years, of which 85 patients sufferents from thoracic vertebral fracture, 27 were thoracic degencrative disease, 12 were thoracic tuberculosis and 8 were thoracic tumor. Results ：A total of 788 thoracic pediele screws were placed by free hand technique, and the most of screws were implanted in low thoracic segments（%0-%2） while the least in %. Massive hemorrhoea,leakage of cerebrospinal fluid and air leakage didn＇t occurre during operation. Thirteen thoracic pedicle screws were re-implanted during operation due to malposition. There are no perioperative complications expect for intercostal numbness founded in 2 patients and the symptom disappeared after 2 months therapy. Conclusion： It is a reliable tech- nique to use the basis of transverse process as the position for pedicle screw implantation, which solve the difficulty of ascertainment the entry point of thoracic pedicle serews. Thoracic pedicle screws can be managed accurately,safely and reliably based on careful manipulation and imageology data.

关 键 词：胸椎 骨折固定术 骨科手术方法 解剖 

分 类 号：R682.3[医药卫生—骨科学] R737.9[医药卫生—外科学]