个体化置钉技术治疗Lenke Ⅰ型脊柱侧凸  

Individual pedicle screws placement for correction of Lenke Ⅰscoliosis

作　　者：殷海东[1] 黄明光[1] 黄东生[2] 彭焰[2] 杜开利[2] 杜庆钧[1] 

机构地区：[1]广东省佛山市顺德第一人民医院骨科,528300 [2]中山大学第二附属医院骨科,广州市510120

出　　处：《中国矫形外科杂志》2010年第11期899-902,共4页Orthopedic Journal of China

基　　金：广东省医学科研基金资助项目(编号:B2009241)

摘　　要：[目的]探讨个体化置钉技术治疗Lenke Ⅰ型脊柱侧凸的矫形效果。[方法]将2006年3月～2009年9月住院治疗的38例LenkeⅠ型脊柱侧凸患者随机分为标准置钉组(19例)和个体化置钉组(19例),术前两组病例的年龄、冠状面Cobb’s角、T5～12后凸Cobb’s角、柔韧性和顶椎旋转度无显著性差异(P>0.05)。标准置钉组术中均采用文献推荐的胸椎进钉点选择方法,而个体化置钉组则根据术前CT预先设计出的胸椎进钉点来指导术中的进钉点选择。术后利用SPSS11.5软件比较两组的手术时间、术中出血量、固定节段、Cobb’s角矫正率、顶椎去旋转率及置钉准确率。[结果]两组病例的手术时间、术中出血量、固定节段、Cobb’s角矫正率均无显著性差异(P>0.05)。个体化置钉组的置钉准确率和顶椎去旋转率均高于标准置钉组(P值分别为0.001、0.02)。[结论]个体化置钉技术可显著提高椎弓根螺钉植入的准确性,并提高Lenke Ⅰ型脊柱侧凸的横断面矫形效果。[Objective]To evaluate the correction effects in patients with Lenke Ⅰ adolescent idiopathic scoliosis（AIS） by using individual pedicle screws placement method. [Methods]A total of 38 patients with Lenke Ⅰ AIS documented in the author’s hospital from Mar.2006 to Sep.2009 were randomly divided into the standard group（19 cases） and individually treated group （19 cases）. No significant difference were found between two groups in factors including mean ages,flexibility of thoracic curve,rotational degree of apical vertebrae,Cobb’s angle in major thoracic curve and T5-T12 kyphosis. Furthermore,the pedicle screws entrance point in the standard group has been described as the previous literatures and the entrance point in the individually treated group was designed by surgeons based on CT scans before the surgery. The differences between these two groups on operation time,blood losing,fixation segments,accuracy in placement pedicle screws,correction rate in Cobb’s angle and rotational degree of apical vertebrae were analyzed by SPSS 11.5 software.[Results]There were no significant difference in operation time,blood losing,fixation segments,correction rate in Cobb’s angle between these two groups（P〉0.05）. However,the accuracy in placement pedicle screws and derotation rate of apical vertebrae were much higher in the individually treated group than those in the standard group （P=0.001,0.02）.[Conclusion]The accuracy in placement pedicle screws and correction effects on transverse plane of patients with Lenke Ⅰ AIS can be improved significantly by individual selection of entrance point.

关 键 词：胸椎 脊柱侧凸 椎弓根螺钉 螺旋CT 三维重建 

分 类 号：R687.3[医药卫生—骨科学]