自制腰骶椎经皮椎弓根螺钉置入定位器在腰椎骨折手术中的应用  

Clinical application of self-designed guide for percutaneous placement of lumbosacral pedicle screws in surgery of lumbar vertebral fracture

作　　者：刘瑾[1] 郭虎兵[1] 谈敬忠 于新福[1] 黄杰[1] 陈立启[1] 

机构地区：[1]甘肃省天水市第一人民医院骨一科,741000

出　　处：《中华创伤骨科杂志》2016年第7期574-578,共5页Chinese Journal of Orthopaedic Trauma

基　　金：中国专利号：ZL201320273538.0基金项目：甘肃省卫生行业科研计划项目（GSWST2013-18）

摘　　要：目的探讨自行研制的腰骶椎经皮椎弓根螺钉置入定位器在腰椎骨折手术中的应用价值。方法回顾性分析自2012年5月至2015年3月行经皮椎弓根螺钉复位固定的143例腰椎骨折患者资料，根据术中有、无使用自行研制的定位器分为定位器组（69例）和徒手组（74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。比较两组患者的单钉定位时间、穿刺准确率、透视次数、手术时间、术中出血量、住院时间。结果定位器组单枚螺钉定位时间、穿刺准确率、透视次数、手术时间均优于徒手组，差异有统计学意义（P〈0．05）。术中出血量、住院时间两组间比较差异均无统计学意义（P〉0．05）。定位器组和徒手组患者术后分别获12～16个月（平均12．9个月）和12～18个月（平均13．2个月）随访。所有患者骨折均一期愈合，无神经根、硬膜囊损伤等并发症发生。结论自制的腰骶椎经皮椎弓根螺钉置入定位器能明显提高穿刺置钉的准确性，大大缩短手术时间、减少术中透视次数，值得临床推广应用。Objective To evaluate our self-designed guide used clinically in percutaneous placement of lumbosacral pedicle screws in surgery of lumbar vertebral fractures. Methods From May 2012 to March 2015, 143 patients with lumbar vertebral fracture were treated with reduction and fixation using per- cutaneous lumbosacral pedicle screws in our department. Percutaneous placement of lumbosacral pedicle screws was assisted by our self-designed guide in 69 of them（guide group） but not in the other 74 cases （manual group）. The 2 groups were compatible in preoperative general data （ P 〉 0. 05）. The 2 groups were compared in terms of localization time for a single screw, puncture accuracy, times of intraoperative fluo- roscopy, operation time, intraoperative blood loss, and hospital stay. Results The guide group had significantly better localization time for a single screw, puncture accuracy, times of fluoroscopy and operation time than the manual group （ P 〈 0. 05）, but the 2 groups showed no significant differences in intraoperative blood loss and hospital stay （ P 〉 0. 05）. The guide group obtained an average follow-up of 12. 9 months （from 12 to 16 months） while the manual group obtained an average follow-up of 13.2 months （from 12 to 18 months）. All fractures healed primarily, without complications like injuries to nerve root or dural sac. Conclusion Our self-designed guide is recommendable because it can obviously improve accuracy of placement of lumbosacral pedicle screws, shorten operation time, and decrease times of intraoperative fluoroscopy.

关 键 词：腰椎 骨折固定术 内 骨钉 定位器 

分 类 号：R687.3[医药卫生—骨科学]