椎弓根镜下微创经皮椎弓根钉置入技术报道及初步应用  

Report and preliminary application of percutaneuos pedicle screw placement with pedicle endoscopy system technology

作　　者：何二兴[1] 郭倞[1] 尹知训[1] 郭炼锦 高巨洲 温涛[1] 邓贤超 陈镜臣 

机构地区：[1]广州医科大学附属第一医院脊柱外科广州骨科研究所,广东广州510000

出　　处：《中国骨与关节损伤杂志》2017年第5期479-482,共4页Chinese Journal of Bone and Joint Injury

基　　金：广州医科大学附属第一医院协同创新项目(201506-gyfyy)

摘　　要：目的设计一种新型脊柱内窥镜系统——椎弓根镜系统,探讨在该系统下微创经皮置入椎弓根钉的可行性和安全性。方法椎弓根镜系统设计的工作通道为双通道,内镜通道用于放置小型内窥镜定位螺钉进入点,螺钉通道用于在内镜可视状态下置入椎弓根钉。回顾性分析自2014-01—2015-06接受微创腰椎融合术的16例腰椎间盘突出并退行性不稳,术中在椎弓根镜辅助下经皮置入长臂万向螺钉。记录单枚螺钉置钉时间、置钉出血量、置钉时X线暴露次数和置钉调整次数,术后行CT扫描评估螺钉位置。结果共置入78枚螺钉,单枚螺钉置钉时间7~26(9.8±5.6)min,置钉出血量5~33(10.3±7.8)ml,置钉时X线暴露次数1~5(2.5±1.6)次,置钉调整次数0~4(1.8±1.3)次。术后CT显示螺钉位置:0级72枚(92.3%),1级4枚(5.1%),2级2枚(2.6%)。3枚(3.8%)螺钉轻度侵犯小关节。本组术后随访6~18个月,无钉棒松动、断裂发生。结论新型椎弓根镜辅助下经皮置入椎弓根钉的安全性和精确性均较理想,在保证手术质量的同时还能有效降低术中对患者和医护人员的X线暴露量。Objective To design a novel spinal endoscopy system-pedicle endoscopy, and to investigate the feasibility and safety of minimally invasive pereutaneous pedicle screw placement under this system. Methods The new pedicle endoscopy system was used a rigid operating sheath which contains two channels, one for placement of a micro-endoscope and the other for endoscopically assisted screw insertion. From January 2014 to June 2015, sixteen patients with degenerative lumbar diseases undergoing minimally invasive lumbar interbody fusion surgery were recruited. During surgery, pedicle endoscopy was applied to place lumbar screws percutaneously. Screw insertion time, blood loss, fluoroscopy times and screw adjustment times were recorded. Postoperative computed tomography （CT） scans were obtained for assessment of pedicle screw accuracy. Results A total of 78 screws were inserted. Screw insertion time was 7-26 （9.8±5.6）rain, blood loss was 5-33 （10.3±7.8）ml, fluoroscopy times were 1-5（2.5±1.6）, and screw adjustment times were 0-4（1.8±1.3）. Postoperative CT showed that screw position was grade 0 in 72 screws（92.3%）, grade 1 in 4 screws（5.1%）, and grade 2 in 2 screws（2.6%）. Only 3 screws（3.8%） had low-grade facet joint violation. Postoperative follow-up was 6-18 months, no screw/rod loosening or breakage was noted. Conclusion The safety and accuracy of percutaneous pedicle screw placement under the assistance of the novel pedicle endoscopy are satisfactory. It not only ensures the quality of surgery, but also can effectively reduce the intraoperative X-ray exposure to patients and medical staffs.

关 键 词：椎弓根镜系统 经皮置钉 椎弓根钉 微创 精确性 

分 类 号：R681.5[医药卫生—骨科学]