万向椎弓根螺钉在脊柱畸形后路矫正中的应用  

The Application of Polyaxial Pedicle Screw in Posterior Correction of Spine Deformity

作　　者：杨华[1] 邢维平[1] 宁旭[1] 尚显文[1] 张皓[1] 

机构地区：[1]贵阳医学院附属医院脊柱外科,贵州贵阳550001

出　　处：《中国现代医学杂志》2012年第24期60-63,共4页China Journal of Modern Medicine

摘　　要：目的分析和总结万向椎弓根螺钉在脊柱畸形后路矫正中的矫正方法及矫正效果。方法应用万向椎弓根螺钉治疗各种脊柱畸形17例,术前使用多种方法减轻脊柱畸形程度,术中强调使用原位转钉等方法矫正脊柱三维畸形。测量术前及术后脊柱主要结构性侧凸平均Cobb角;测量术前及术后脊柱矢状面胸段、胸腰段和腰段的角度,判断脊柱矢状面是否正常化;采用椎弓根标记法测量术前及术后顶椎椎体旋转程度(除外3例顶椎全切病例)。记录有无内固定并发症。结果术前脊柱主要结构性侧凸平均Cobb角63.18°,术后平均25.35°,秩和T=153.00,P<0.005,差异有显著性。矢状面异常的15例病例术后复片显示矢状面正常化。顶椎椎体旋转(除外3例顶椎全切病例),术前Ⅰ度3例,术后均为0度,余病例均有不同程度的旋转畸形残留。所有病例无重要血管、神经损伤,无内置物松动、滑脱或断裂。结论万向椎弓根螺钉可以简化脊柱畸形的操作,增加安全性,同时可以取得良好的矫正效果。【Objective】 To analyze and summarize the correction methods and effects of polyaxial pedicle screw in posterior correction for spine malformation.【Methods】 Polyaxial pedicle screws were used in treating 17 cases of spine deformity of various types.Methods were used to reduce the degrees of spine deformity before the operation and methods including screw-rotating in situ were strongly recommended in spine 3-d deformity correction.The average Cobb angle of main structural scoliosis was measured before and after the operation respectively.The angles of thoracic segment,thoracolumbar segment were measured before and after the operation respectively.Pedicle markers were used to measure the top vertebrae rotation before and after the operation respectively（excluding the 3 cases of apical vertebrectomy）.Complications resulted from internal fixation were carefully observed and recorded.【Results】 The pre-operative average Cobb angle of main structural scoliosis was 63.18.while the post-operative one was 25.35.The rank-sum T=153.00 and P 0.005 suggests the difference is statistically significant.Post-operative X-ray exam showed he 15 cases of abnormal sagittal plane were normalized.Among the 15 cases receiving top vertebral rotation,3 cases of grade I were improved to grade 0 while rotation deformity of various degrees were still observed in the rest cases.No important vascular or neural injury,no loosened,slippage,or broken inserters were found in all cases.【Conclusion】 Polyaxial pedicle screw can simplify spine deformity correction,increase the safety while achieving good correction effect.

关 键 词：万向椎弓根螺钉 脊柱畸形 置棒 原位转钉 平衡 脊椎切割 

分 类 号：R682[医药卫生—骨科学]