下颈椎椎弓根螺钉外侧壁穿破相关因素分析  

Analysis of factors related to perforation of lateral wall by lower cervical vertebral pedicle screw

作　　者：杨振东[1] 解京明[1] 王迎松[1] 张颖[1] 赵智[1] 刘路平[1] 赵伟[1] 

机构地区：[1]昆明医学院第二附属医院骨科,650101

出　　处：《中华创伤杂志》2011年第8期688-691,共4页Chinese Journal of Trauma

摘　　要：目的分析下颈椎椎弓根螺钉应用于颈椎疾患中外侧壁穿破的相关因素。方法回顾性分析2004年7月-2009年7月采用C3～7椎弓根螺钉治疗的颈椎损伤患者214例（1024枚螺钉），其中18例（28枚螺钉）发生外侧壁穿破。结合患者术中探查与手术前、后手术节段椎弓根CT扫描，记录外侧壁穿破者的资料，对其进行统计学分析。结果18例患者共有28枚螺钉发生椎弓根外侧壁穿破。使用向后逐步（Wald法）Logistic回归分析，最终引入两个变量。结论颈椎椎弓根内、外侧壁厚度之比是外侧壁穿破的危险因素；置钉角度与CT测量角度之差为外侧壁穿破的保护因素。Objective To analyze the risk factors related to perforation of lateral wall by lower cervical pedicle screw instrumentation in the treatment of cervical spinal disorders. Methods A retrospective review was made to analyze 214 cervical vertebral injury patients （ 1 024 pedicle screws were used） treated with pedicle screw instrumentation at C3-7 from July 2004 to July 2009. Lateral walls of 18 patients were perforated （ a total of 28 pediele screws）. The surgeons assessed the position and the angle of the screw in the pediele, and the relation and the distance between the screw and the pedicle walls by carefully probing intraoperative walls of cervical pedieles and studying postoperative thin-slice computed tomography （CT） scan of the fixed vertebral segments of the cervical spine. The data of patients with lateral wall perforation was recorded and analyzed statistically. Results Perforation of the lateral wall oc- curred in 18 patients （28 pedicle screws）. Backward step by step Logistic regression analysis was used and two variables were selected in the end. Conclusions Ratio variance between inner and lateral wall is the risk factor of perforation in the lateral wall associated with lower cervical pedicle screw instrumentation, while the angle variance between implanted screws and CT measurements is the protection factor of perforation in the lateral wall.

关 键 词：脊柱骨折 颈椎 椎弓根 危险因素 

分 类 号：R687.3[医药卫生—骨科学]