椎弓根置钉导向器在重度脊柱畸形患者矫形手术中的应用  

Application of pedicle screwing guider to severe spinal deformity

作　　者：王文刚[1] 夏磊[1] 罗明 张华峰 李明君[2] 杨宁宁[1] 申明奎 许根中 刘磊[1] WANG Wengang;XIA Lei;LUO Ming

机构地区：[1]郑州大学第一附属医院骨科,郑州市450052 [2]郑州大学第一附属医院肿瘤科,郑州市450052

出　　处：《中国脊柱脊髓杂志》2019年第5期407-413,共7页Chinese Journal of Spine and Spinal Cord

基　　金：河南省科技攻关项目(编号:172102310090)

摘　　要：目的:探究3D打印的个性化椎弓根置钉导向器对于重度脊柱畸形患者(主弯Cobb角≥90°)矫形手术中辅助置钉的安全性和有效性。方法:回顾我院2017年1月~2017年9月采用椎弓根置钉导向器辅助置钉的13例(9女4男)重度脊柱畸形患者,平均手术年龄12.9±3.1岁(10~19岁),随访时间13.8±1.9个月(12~18个月)。术后2周CT测量椎弓根螺钉突破椎弓根皮质的程度,并将其分成0级(未突破椎弓根皮质)、1级(突破<2mm)、2级(突破2~4mm)、3级(突破>4mm),其中0级和1级认定为螺钉置入准确。测量并比较术前、术后2周、末次随访的主弯Cobb角、后凸角、冠状面平衡、脊柱矢状位轴,记录置钉相关并发症。结果:13例重度脊柱畸形患者术中在119枚椎弓根置钉导向器(238个椎弓根导向孔)的辅助下,成功置入232枚椎弓根螺钉,辅助置钉成功率97.5%(232/238)。依据CT测量分级,0级、1级、2级和3级螺钉数依次为111枚、84枚、33枚和4枚,置钉准确率为84.1%(195/232)。术后2周,主弯Cobb角由术前的110.6°±15.2°纠正至52.3°±16.2°(P<0.05);后凸角由术前的58.3°±20.6°纠正至35.7°±10.4°(P<0.05);冠状面平衡由术前的2.8±1.7cm纠正至1.7±0.5cm(P<0.05);脊柱矢状位轴由术前的3.1±1.8cm纠正至1.4±0.4cm(P<0.05)。末次随访与术后2周比较,无统计学差异(P>0.05)。至末次随访时,未发生严重的置钉相关并发症。结论:椎弓根置钉导向器可为重度脊柱畸形患者提供准确性较高的辅助导航。Objectives: To explore the safety of 3 D printed personalized pedicle screwing guiders for assisting screw placement during the operation of severe spinal deformity(Cobb angle of major curve ≥90°).Methods: Thirteen patients(9 females and 4 males) with severe spinal deformities who were treated with pedicle screwing guider technology from January 2017 to September 2017 in our hospital were retrospectively an-alyzed. Mean age at the time of surgery was 12.9±3.1 years, ranged from 10 to 19 years. Mean follow-up time was 13.8±1.9 months, ranged from 12 to 18 months. The placement of pedicle screws was evaluated by CT scans two weeks after surgery. According to the degree of pedicle screw breakthrough in the pedicle cor-tex, pedicle screw placement was divided into grade 0(no breach), 1(breach of <2 mm), 2(breach of 2-4 mm) and 3(breach >4 mm), of which grade 0 and grade 1 were determined to be accurate. The preoperative and postoperative radiograph parameters including Cobb angle of major curve, kyphosis, coronal balance and sagittal vertebral axis were also measured and compared. Screw-related complications were recorded. Results:Assisted by 119 pedicle screwing guiders(238 pedicle guide holes), 232 pedicle screws were inserted success-fully for the 13 patients with severe spinal deformity, and the success rate of assisted screw placement was97.5%(232/238). According to the CT classification, the number of grade 0, 1, 2 and 3 was 111, 84, 33 and4, and the accuracy rate of pedicle screw fixation was 84.1%(195/232). Two weeks after surgery, the Cobb angle of major curve was corrected from 110.6°±15.2° to 52.3°±16.2°(P<0.05), and kyphosis was corrected from 58.3°±20.6° to 35.7°±10.4°(P<0.05), coronal balance was corrected from 2.8±1.7 cm to 1.7±0.5 cm(P<0.05), and sagittal vertebral axis was corrected from 3.1±1.8 cm to 1.4±0.4 cm(P<0.05). No serious screw-related complication occurred. Conclusions: The pedicle screwing guider technology provides individualized navigation for patients with severe s

关 键 词：椎弓根置钉导向器 重度脊柱畸形 椎弓根置钉 置钉准确性 

分 类 号：R687.3[医药卫生—骨科学]