基于CT影像的儿童先天性脊柱侧凸胸椎椎弓根螺钉置钉精确性评价  

Evaluation of accuracy of thoracic pedicle screw fixation for congenital scoliosis in children based on CT images

作　　者：郭旭朝[1] 孟钊[1] 王晨[1] 朱华 赵硕[1] 王飞 邹岩 刘俊行 Guo Xuzhao;Meng Zhao;Wang Chen;Zhu Hua;Zhao Shuo;Wang Fei;Zou Yan;Liu Junxing(Department of Orthopaedics,Hebei Children Hospital,Shijiazhuang 050031,Hebei,China)

机构地区：[1]河北省儿童医院骨科,石家庄050031

出　　处：《脊柱外科杂志》2022年第5期307-312,共6页Journal of Spinal Surgery

摘　　要：目的通过CT评价10岁以下先天性脊柱侧凸儿童徒手置入胸椎椎弓根螺钉的精确性。方法回顾性分析2014年12月—2018年12月收治的26例先天性脊柱侧凸患儿临床资料。所有患儿均为单胸弯或胸腰弯,术中依据胸椎解剖标志结合C形臂X线机定位进行徒手置钉。术后在CT上测量螺钉穿破椎体(包括椎弓根)骨皮质内侧、外侧或前侧的距离,<2 mm为准确置钉,≥2 mm为异常置钉。同时记录术中或术后是否发生置钉相关并发症。结果胸椎区共置入椎弓根螺钉165枚,每例患儿置入6.3±1.8枚螺钉。准确置钉129枚(78.2%),异常置钉36枚(21.8%)。形态异常椎异常置钉率(41.8%,23/55)高于正常椎(11.8%,13/110),且形态异常椎凹侧异常置钉率(77.8%,14/18)高于凸侧(24.3%,9/37);顶椎区异常置钉率(35.0%,21/60)高于非顶椎区(14.3%,15/105),且顶椎区凹侧异常置钉率(50.0%,12/24)高于凸侧(25.0%,9/36);差异均有统计学意义(P<0.05)。术中及术后未发生置钉相关并发症。结论对10岁以下先天性脊柱侧凸儿童进行胸椎徒手置钉具有较高的精确性,术后很少发生置钉相关并发症。形态异常椎体、顶椎区置钉时需谨慎操作,尤其是这两个区域的凹侧置钉时要慎之又慎。Objective To evaluate the accuracy of freehand thoracic pedicle screw placement in children with congenital scoliosis under 10 years old by CT.Methods The clinical data of 26 children with congenital scoliosis treated from December 2014 to December 2018 were analyzed retrospectively.All the children were single thoracic curvature or thoracolumbar curvature.The pedicle screws were placed by hand during the operation according to the thoracic anatomical landmarks combined with positioning of C-arm X-ray machine.After operation,the distance of screw penetration into the medial,lateral or anterior cortex of the vertebral body(including the pedicle)was measured on CT,<2 mm as accurate placement,≥2 mm as abnormal placement.Complications related to pedicle screw placement were also noted during or after the operation.ResultsA total of 165 pedicle screws were placed in the thoracic region,and 6.3±1.8 screws were placed in each child.The 129(78.2%)screws were accurately placed and 36(21.8%)suffered an abnormal placement.The abnormal placement rate of the abnormal morphology vertebra(41.8%,23/55)were higher than that of the normal vertebra(11.8%,13/110),and the abnormal placement rate on the concave side of abnormal morphology vertebra(58.3%,14/24)was higher than that on the convex side(29.0%,9/31);the abnormal placement rate in the apical vertebral region(35.0%,21/60)was higher than that in the non-apical vertebral region(14.3%,15/105),and the abnormal placement rate on the concave side in the apical vertebral region(50.0%,12/24)was higher than that in the convex side(25.0%,9/36);the differences were statistically significant(P<0.05).No complications related to screw placement occurred during or after the operation.Conclusions Freehand placement of thoracic pedicle screw in children with congenital scoliosis under 10 years old has a high accuracy,and there are few complications related to screw placement after operation.Screw placement in the abnormal vertebral body and the apical region should be cautious,especially o

关 键 词：儿童 胸椎 脊柱侧凸 骨钉 

分 类 号：R726.823[医药卫生—儿科]