胸腰椎经皮椎弓根螺钉置钉准确性的CT评价  

Accuracy of percutaneous pedicle screw insertion in thoracic and lumbar spine by computer tomography assessment

作　　者：梅晓亮[1] 黄爱兵[1] 赵春明[1] 张威[1] 张文捷[1] 

机构地区：[1]泰州市人民医院骨科,江苏泰州225300

出　　处：《临床骨科杂志》2015年第5期529-531,共3页Journal of Clinical Orthopaedics

基　　金：江苏大学2012年度医学临床科技发展基金(编号:JLY20120127)

摘　　要：目的：应用CT评估经皮椎弓根螺钉固定术置入螺钉的准确性。方法分析85例经皮椎弓根螺钉固定术患者的资料,置入节段为T6~S1。根据术后CT轴位扫描图像以及患者是否出现椎弓根螺钉相关并发症,将椎弓根螺钉位置分级：0级,螺钉位于椎弓根皮质内；1级,螺钉突破椎弓根骨壁但≤2 mm；2级,螺钉突破椎弓根骨壁〉2 mm但无神经受压等症状；3级,出现螺钉相关并发症。结果85例患者共置入380枚椎弓根螺钉,其中胸椎80枚,腰椎280枚,骶椎（S1）20枚。术后CT扫描置入椎弓根螺钉位置：17枚穿破椎弓根外侧壁,10枚穿破椎弓根内侧壁,4枚穿破椎弓根上壁,2枚穿破椎弓根下壁,总体不良置钉率8．7%。根据Mobbs-Raley简易分级标准评判：0级347枚（91．3%）；1级24枚（6．3%）；2级8枚（2．1%）；3级1枚（0．3%）,该例患者出现神经受压症状,行二次翻修术。结论经皮椎弓根螺钉置入术准确性较高,很少发生2级以上置钉位置不佳者,是一项值得推广的技术。Objective To evaluate the accuracy of percutaneous pedicle screws in thoracic and lumbar spine by com-puter tomography. Methods 85 patients treated with percutaneous pedicle screw instrumentation in thoracic and/or lumbar spine were analyzed. The segments of pedicle screw insertion ranged from T6 to S1 . The pedicle screw accura-cy was graded by CT analysis scans, according to the occurrence of screw-related complications. Grade 0：screw with-in cortex of pedicle;Grade 1：screw thread breach of pedicle wall ≤2mm;grade 2： significant screw-related breach〉2mm with no neurological compromise;grade 3：screw related complications. Results All the 380 screws were in-serted in the 85 patients. There were 80 thoracic pedicle screws,280 lumbar pedicle screws, and 20 sacral （ S1 ） ped-icle screws. The placement of pedicle screws after the operation by CT scanning：17 pedicle screws encroached the pedicle from the lateral wall,10 pedicle screws encroached the pedicle from the medial wall, while 4 from the up wall and 2 from the lower wall. The total rate of inaccuratly placed pedicle screws was 8. 7%. Among the 380 screws,347 （91. 3%） were graded grade 0,24（6. 3%） into grade 1, 8（2. 1%） into grade 2 by Mobbs-Raley classification standard. Only one patient （0. 3%） with grade 3 in one screw developed neurological compromises and relieved after revision surgery. Conclusions The accuracy rate of percutaneous pedicle screw insertion in thoracic and lumbar spine is relatively high,inaccurate screws with grade 2 and above rarely occur. It is a valuable technique.

关 键 词：胸椎 腰椎 经皮椎弓根螺钉 置钉准确性 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]