胸腰椎椎弓根内固定螺钉置钉失误分析
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江苏省兴卫工程医院重点人才项目(RC2007060)


Analysis of fault with the technique of transpedicle screw fixation in the thoracolumbar
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    摘要:

    目的:探讨胸腰椎椎弓根内固定螺钉置钉失误率-失误的原因及预防措施-方法:回顾性分析2008~2010年262例患者行胸腰椎椎弓根内固定置入1 207枚螺钉术后的临床表现-CT-X线结果,包括螺钉在椎弓根内的位置-角度和损伤或穿破椎弓根骨皮质的情况-并根据其穿出骨皮质的距离分为4度,即:Ⅰ度0~2 mm,Ⅱ度2~4 mm,Ⅲ度4~6 mm,Ⅳ度6~8 mm-结果:41枚螺钉(3.40%)突破了椎弓根皮质,其中Ⅰ度24枚,Ⅱ度12枚,Ⅲ度5枚,并发神经根损伤3例(1.15%)-结论:经椎弓根固定安全路径狭小,术前要认真阅读分析影像资料,术中透视确认,仔细探查,选用合适规格螺钉,可以有效地减少胸腰椎椎弓根螺钉的置钉失误-

    Abstract:

    Objective:To discuss the fault ratio of transpedicle screw fixation in the thoracolumbar ,and analysis the causation and clinical treatments of it. Methods:From 2008 to 2010,total 262 cases that had thoracolumbar disease were treated with 1 207 pedicle screws fixation. The CT and X-ray features of 262 postoperative transpedicle screws placement were analyzed retrospectively, including the screw position, angle and cortical injury. And according to the distance of the screw thread perforated pedical cortical bone, the cortical injuries were divided into four degree,namely Ⅰ 0~2 mm, Ⅱ 2~4 mm,Ⅲ 4~6 mm,Ⅳ 6~8 mm. Results:Of all the pedicle srews,CT and X-ray showed that the pedicle cortical bones were often injured by the screw thread. There were 41 (3.40% )screws perforating the cervical pedicle,24 withⅠ, 12 with Ⅱ,5 with Ⅲ, and 3 with nerve root injury(1.15%). Conclusion:Although pedicles of thoracolumbar are narrow, many faults of transpedicle screw fixation of thoracolumbar can be avoided, if we read images clearly before operations, use radiation to locate, probe to check screw channel and choose. suitable screws.

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黄 华,曹晓建.胸腰椎椎弓根内固定螺钉置钉失误分析[J].南京医科大学学报(自然科学版),2011,(8):1231-1234

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  • 收稿日期:2011-04-07
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