胸椎椎弓根螺钉置入技术治疗胸椎骨折患者的准确性和安全性  

Evaluation of the Accuracy and Safety of Thoracic Pedicle Screw Placement in Treatment of Paints with Thoracic Fracture

作　　者：王维霖 赵永旭 王琳 WANG Weilin;ZHAO Yongxu;WANG Lin(Department of Orthopaedics,Dalian Fifth People Hospital,Dalian 116022,China)

机构地区：[1]大连市第五人民医院骨外科,辽宁大连116022

出　　处：《中国医药指南》2020年第25期97-98,共2页Guide of China Medicine

摘　　要：目的探讨胸椎椎弓根螺钉置入技术治疗胸椎骨折患者的准确性和安全性。方法100例胸椎骨折患者手术前实施脊柱标准俯卧位CT加密扫描,并根据患者的情况测量椎体前缘至进针点和入钉点的深度、进针角度和直径,根据测量数据确定椎弓根螺钉放置的方向和深度,在手术完毕后,实施脊柱X线+CT加密扫描。对置钉的安全性和准确性进行评价。结果100例患者共置入胸椎椎弓根螺钉220枚,经CT扫描及X线成像显示,200枚螺钉完全置入椎弓根皮质骨,胸椎椎弓根螺钉完全置入率为90.91%,具有较高的准确性和安全性;20枚螺钉偏位,其中4枚螺钉偏外,5枚螺钉位于前外侧,1枚螺钉位于主动脉附近,3枚螺钉位置偏下,2枚螺钉直径过大导致椎弓根内壁肿胀移位,5枚螺钉误入椎管。结论胸椎骨折患者通过术前CT扫描测量椎弓根数据可为手术中准确置钉提供重要参考。保证胸椎椎弓根螺钉准确放置的关键因素是术中X线透视和解剖标记。术后CT扫描能准确反映椎弓根螺钉位置偏差,能反映椎弓根螺钉与邻近结构的位置及关系,螺钉脱位在上胸椎较为常见。Objective To discuss he accuracy and safety of thoracic pedicle screw placement in treatment of paints with thoracic fracture.Methods 100 cases of thoracic fracture who implemented the standard prone position CT scan of spine before operation,and according to the patient's condition,the depth from the anterior edge of the vertebral body to the needle insertion point and the nail insertion point,needle angle and diameter.were measured,and according to the measured data,the direction and depth of pedicle screw placement were determined,and were implemented the X-ray and CT scan of spine after the operation.Then,the safety and accuracy of nail placement were evaluated.Results 220 cases of thoracic pedicle screws were implanted in 100 patients,the CT scan and X-ray imaging showed that 200 screws were completely inserted into the cortical bone of the pedicle,the complete implantation rate of thoracic pedicle screw was 90.91%,it had high accuracy and safety;20 screws were out of position,4 screws were out of position,5 screws were located anterolateral,1 screw was located near the aorta,3 screws were lower,the diameter of 2 screws were too large,leading to swelling and displacement of the pedicle inner wall,and 5 screws were mistakenly inserted into the spinal canal.Conclusion The data of pedicle measured by CT scan before operation in paints with thoracic fracture can provide an important reference for accurate screw placement during operation.The key factors to ensure the accurate placement of pedicle screws are X-ray fluoroscopy and anatomical markers.Postoperative CT scan can accurately reflect the position deviation of pedicle screw and the position and relationship between pedicle screw and adjacent structures.Screw dislocation is common in upper thoracic spine.

关 键 词：胸椎骨折 胸椎椎弓根螺钉 准确性 安全性 

分 类 号：R687.3[医药卫生—骨科学]