术中锥束CT辅助下脊柱侧凸畸形椎弓根螺钉置入的精确性及安全性  

Accuracy and safety of pedicle screw placement for spinal deformity under intraoperative CT-assisted

作　　者：赵阳阳[1,2] 谢雁春 李卓 张猛[1] 刘国利 于海龙 ZHAO Yang-yang;XIE Yan-chun;LI Zhuo;ZHANG Meng;LIU Guo-li;YU Hai-long(Department of Orthopedic,General Hospital of Shenyang Military Region,Shenyang Liaoning 110016,China;Graduate School,Dalian Medical University,Dalian Liaoning 116044,China)

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016 [2]大连医科大学研究生院,辽宁大连116044

出　　处：《局解手术学杂志》2018年第10期719-722,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：辽宁省自然科学基金计划重点项目(20170540958);2015全军医学科技青年培育项目计划(15QNP004

摘　　要：目的评估术中锥束CT辅助下脊柱侧凸畸形矫形椎弓根置钉的精确性和安全性。方法收集2014年3月至2017年3月在我院行手术治疗的28例脊柱侧凸畸形患者,术中行锥束CT扫描观察椎弓根螺钉位置和椎弓根破坏情况,术后复查传统CT评价螺钉植入的精确性及安全性。结果 28例脊柱侧凸畸形患者均顺利完成手术,共置入椎弓根螺钉总数为402枚;根据Gertzbein-Robbins分级:0级377枚,1级13枚,2级8枚,3级4枚,4级0枚;术中根据锥束CT扫描图像进行位置修正的螺钉共64枚,术后无患者出现神经及血管损伤症状。结论术中锥束CT扫描能够提高脊柱侧凸畸形矫形手术中的椎弓根置钉的精确性,减少术中神经损伤等并发症的发生。Objective To evaluate the accuracy and safety of pedicle screw placement for spinal deformity under intraoperative CT-assisted. Methods The clinical data of 28 patients with spinal deformity,who underwent intraoperative CT-assisted placement of pedicle screws in our hospital from March 2014 to March 2017,were analyzed retrospectively. Intraoperative CT-assisted placement of pedicle screws was to observe the position of pedicle screws and adjust the screw position. The safety of pedicle screw fixation was assessed by the postoperative complications. Results All 28 patients of scoliosis were successfully performed surgery. A total of 402 pedicle screws were placed in the spines and the placements of 64 screws of them were adjusted according to intraoperative CT findings. Of 402 screws,377 were placed in the pedicles,13 by grade 1 pedicle breach,8 by grade 2 pedicle breach and 4 by grade 3 pedicle breach according to Gertzbein-Robbins classification of pedicle screw placement accuracy. No complication was directly related to the screws placement. No patient required reoperation due to the misplacement of the pedicle screws. Conclusion Intraoperative cone-beam CT scan can help the surgeon improve the accuracy and safety of pedicle screw placement for spinal deformity with less complication.

关 键 词：脊柱侧凸畸形 椎弓根 术中CT 内固定 

分 类 号：R687.3[医药卫生—骨科学]