徒手置入277枚腰椎椎弓根螺钉的临床分析  

A clinical analysis of manual placement of 277 lumbar pedicle screws

作　　者：杨华[1] 邢维平[1] 尚显文[1] 张皓[1] 宁旭[1] 

机构地区：[1]贵阳医学院附属医院脊柱外科,550001

出　　处：《重庆医学》2010年第7期801-803,共3页Chongqing medicine

摘　　要：目的探讨徒手置入腰椎椎弓根螺钉的手术技巧,以便准确、可靠的徒手置入腰椎椎弓根螺钉。方法2007年4月至2009年4月对骨折、滑脱、椎管狭窄等不同情况的腰椎徒手进行椎弓根钉置入共277枚,记录置钉过程中穿破椎弓根皮质的部位、螺钉松动的原因、有无术中并发症等。术后评价螺钉位置,观察有无术后并发症的发生。结果术后复查正侧位X线片,优良率为95.3%。置钉过程中发生椎弓根皮质穿破22枚,总发生率为7.94%,不同节段腰椎之间发生率的差异无统计学意义(P>0.05)。术中因开路器改道、螺钉植入后发生螺钉松动3枚,因骨质疏松致螺钉松动2枚。术中未发生神经、血管、脏器损伤及脑脊液漏等并发症。术后观察无螺钉滑脱病例,无瘫痪加重病例,无神经、血管、脏器损伤病例。结论熟悉腰椎椎弓根螺钉植入的每一个步骤及影响因素,徒手置入过程中重视手感并及时采取应对策略进行调整,可以获得安全、满意的置钉效果。Objective To summarize and explore safe and accurate manual placement of lumbar pedicle screws. Methods Manual placement of 277 pedicle screws for conditions of lumbar fracture,lumbar spondylolisthesis,and lumbar spinal stenosis were car ried out between April 2007 and April 2009. Locations of cortical perforation,reasons of loosened screws,and intraoperative eompli cations were recorded. Post-operative assessemnt was made on screws＇ position and post-operative complications were also under observation. Results Postoperative AP and lateral radiography was carried out to evaluate the placement and the correct rate was 95.3 % by the criterion of Tang Tiansi. Perforation of pedicle cortex was observed in 22 intraoperative screw insertion. The total in cidence rate was 7.91 %. The differences between the incidence rates at different lumbar regions were statistically insignificant（P〉 0.05） ,which meant there was no difference between different lumbar regions in terms of perforation of cortex. Three ostoperative Loosened screws caused by intraoperative route change by path-opening screws and two postoperative loosened screws caused by osteoporosis were observed. No complication, including neurological, vasular, and organic injuries or leakage of cerebrospinal were observed during the operalion. No screw falling off, no deterioration of paralysis, and no neurological, vascular, and organic injury were observed in postoperative observation. Conclusion Mastering every step of pedicle seew insertion and impact factors,and paying close attention to inwaoperative hand feeling and making neeessar adjustmen if needed are important to safe and accurate pedicle screw placement.

关 键 词：徒手 椎弓根 螺钉 手感 

分 类 号：R687.3[医药卫生—骨科学]