经第2骶椎骶髂螺钉技术与髂骨螺钉技术在儿童腰骶手术中的应用  

Application and effect of the S2AI screws and iliac screw in lumbosacral surgery in children

作　　者：范竟一[1] 张学军[1] 李承鑫[1] 郭东[1] 孙保胜[1] 祁新禹[1] Fan Jingyi;Zhang Xuejun;Li Chenxin;Guo Dong;Sun Baosheng;Qi Xinyu(Department of Orthopedics,Beijing Children's Hospital Affiliated to Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《临床小儿外科杂志》2022年第5期463-467,共5页Journal of Clinical Pediatric Surgery

基　　金：国家重点研发计划(2016YFC1000806)。

摘　　要：目的初步总结应用经第二骶椎骶髂螺钉(second sacral alar-iliac,S2AI)和髂骨螺钉(iliac screw,IS)技术用于儿童腰骶手术的相关经验。方法以首都医科大学附属北京儿童医院矫形骨科2015年7月至2020年6月应用S2AI(S2AI组,21例)和IS(IS组,17例)技术治疗的38例腰骶畸形患儿为研究对象,对比两组患儿年龄、性别、随访时间、翻修次数、出血量、平均置钉时间、是否行扩大剥离、伤口感染、内固定松动、内固定断裂、是否采用附加连接装置、一次置钉成功率、置钉直径、疼痛级别、伤口愈合时间、术后住院时间、胸弯自发矫正、腰弯矫正度、骶骨骨盆角矫正度等资料。结果S2AI组和IS组行扩大剥离的病例数分别为5例和12例,差异具有统计学意义(χ^(2)=8.315,P=0.004);内固定松动的病例数分别为2例和8例,差异具有统计学意义(χ^(2)=5.028,P=0.025);采用附加链接装置的病例数分别为1例和14例,差异具有统计学意义(χ^(2)=3.673,P<0.01)。结论儿童先天性脊柱畸形(尤其是腰骶畸形)治疗较为困难。S2AI技术与IS技术相比,具有剥离面小、内固定松动率低、采用附加连接装置少等优点。但要熟练掌握其技术要领及使用规范,还需要长期的学习和实践,对患儿术后骶髂关节疼痛的评判也需要长期随访。Objective To summarize the experience in applying the Second Sacral alar-iliac(S2AI)screw and the Iliac screw.Methods Retrospective analysis was conducted for 38 lumbosacal malformation cases treated by S2AI screw(n=21)and iliac screw(n=17)techniques from July 2015 to June 2020.Data of patients'age,sex,follow-up time,number of revision,blood loss,average time of screwing,wound expansion,wound infection,screw loosening,screw breakage,connection devices application,screwing success rate,screw diameter,pain level,healing time,postoperative length of stay,spontaneous thoracic curve correction,lumbar curve correction,sacrum pelvic angle correction was recorded.Results There were 5 cases(23.8%)and 12 cases(70.5%)of wound expansion in the S2AI group and ailiac screw group respectively with a statistical significant difference(χ^(2)=8.315,P=0.004).There were 2 cases(9.5%)and 8 cases(40.1%)had internal fixation loosening in the S2AI group and ailiac screw group respectively with a statistical significant difference(χ^(2)=5.028,P=0.025).There were 1 case(4.7%)and 14 cases(82.3%)applying connection devices in the S2AI group and ailiac screw group respectively with a statistical significant difference(χ^(2)=3.673,P<0.01).Conclusion It is difficult to treat congenital spinal deformity in children.Compared with iliac screw technique,S2AI screw technique has the advantages of smaller stripping surface,lower loosening rate of internal fixation and less use of additional connection devices.However,long-term study and practice are needed to master its technical essentials and standard.Long-term follow-up is also required to evaluate postoperative sacroiliac joint pain.

关 键 词：腰骶部/外科学 髂骨/外科学 内固定器 儿童 

分 类 号：R726.8[医药卫生—儿科]