自行研制的无创经皮经椎弓根三维定位导向器在经皮椎弓根螺钉固定术中的应用  

A self-designed three.dimensional guiding instrument for percutaneous thoracolumbar pedicle screw implantation

作　　者：龙浩[1] 陈海燕[2] 吴景明[3] 董伟强[3] 汤敏生[4] 邹华章[5] 白波[3] 

机构地区：[1]广州医科大学附属第四医院骨科,511447 [2]广州医科大学附属第二医院骨科 [3]广州医科大学附属第一医院骨科 [4]广州医科大学荔湾医院骨科 [5]南方医科大学南方医院新塘医院骨科

出　　处：《中华创伤骨科杂志》2015年第12期1042-1046,共5页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技计划项目（20128060100007）;广州市科技计划项目（2012J4100020）中国专利号：ZL201020026944.3

摘　　要：目的评价自行研制的无创经皮经椎弓根三维定位导向器在经皮椎弓根螺钉固定术中的应用效果。方法回顾性研究2014年1月至2015年3月行经皮椎弓根螺钉固定术患者52例，使用三维定位导向器辅助手术的25例患者为定位组，以常规方法徒手定位的27例患者为徒手组。定位组25例59个椎体，男18例，女7例；年龄27—74岁，平均（56．1±12．7）岁；腰椎间盘突出症12例，腰椎不稳4例，骨折9例。徒手组27例67个椎体，男17例，女10例；年龄32—78岁，平均（57．3±13．5）岁；腰椎间盘突出症14例，腰椎不稳5例，骨折8例。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。分别比较两组患者的穿刺定位时间、术中x线透视次数、水平面椎弓根螺钉置入角度（TSA）和矢状面椎弓根螺钉置入角度（SSA）的偏差率。结果所有手术均顺利完成。定位组的穿刺定位时间[（7．4±3．2）min]和x线透视次数[（3．4±1．9）次]均少于徒手组[（12．3±4．4）min和（6．4±2．2）次]，差异有统计学意义（P〈0．05）。定位组穿破椎弓根内壁1例，穿破椎弓根外壁1例，螺钉过度头偏或尾偏2例。徒手组穿破椎弓根内壁4例，穿破椎弓根外壁3例，螺钉过度头偏或尾偏3例。定位组TSA角、SSA角偏差率（6．5％±2．6％、9．6％±3．8％）低于徒手组（18．6％±5．8％、16．0％±3．8％），差异均有统计学意义（P〈0．05）。结论自行研制的无创经皮经椎弓根三维定位导向器辅助经皮椎弓根螺钉固定手术可以有效减少经皮椎弓根穿刺定位过程中使用x线透视的次数，缩短手术时间，提高穿刺正确率，不增加手术并发症，可有效辅助临床经皮椎弓根内固定术。Objective To evaluate the clinical eeficacy of the self-designed three-dimensional guiding instrument used in the implantation of pereutaneous thoracolumbar pedicle screws. Methods This study enrolled 52 patients who had undergone internal fixation with percutaneous thoracolumbar pedicle screws from January 2014 to March 2015 at our department. They were divided two groups, the instrument group and the manual group. There were 18 males and 7 females in the instrument group, with an average age of 56. 1 ± 12.7 years （range, from 27 to 74 years） . Of them, 12 suffered from lumbar disc herniation, 4 from lumbar instability, and 9 thoracolumbar fracture. There were 17 males and 10 females in the manual group, with an average age of 57.3 ± 13.5 years （range, from 32 to 78 years）. Of them, 14 suffered from lumbar disc herniation , 5 from lumbar instability, and 8 from thoracolumbar fracture. There were no significant differences in general clinical data between the 2 groups preoperation （ P 〉 0. 05） . The positioning time, intraoperative fluoroscopy frequency, transverse screw angle （TSA）, and sagittal screw angle （SSA） were compared between the 2 groups. Results All the operations were performed uneventfully. The positioning time （7. 4 ± 3.2 min） and intraoperative fluoroscopy frequency （3.4 ± 1.9 times） in the instrument group were significantly less than in the manual group （12. 3 ±4. 4 min and 6. 4 ±2.2 times, respectively） （P 〈 0.05）. The interior and exterior pedicle walls were each pierced in one case, and the excessive cephalad or caudal deviation occurred in 2 eases in the instrument group; the interior pedicle wall was pierced in 4 cases, the exterior wall was pierced in 3 cases and the excessive cephalad or caudal deviation occurred in 3 eases in the manual group. The deviation rates of TSA and SSA in the instrument group （6. 5% ± 2.6% and 9. 6% ±3.8%, respectively） were significantly lower than in the manual group（18.6% ±5.8% and 16. 0%± 3.8%, respecti

关 键 词：脊柱骨折 骨折固定术 内 骨钉 定位器 

分 类 号：R687.3[医药卫生—骨科学]