| 术中CT在后路全椎弓根螺钉治疗重度脊柱侧凸中的初步应用 |
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Received:December 13, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 施新革 |
SHI Xin-ge |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 张永刚 |
ZHANG Yong-gang |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
875883840@qq.com |
| 张雪松 |
ZHANG Xue-song |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 崔庚 |
CUI Geng |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 毛克亚 |
MAO Ke-ya |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 王征 |
WANG Zheng |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 董天祥 |
DONG Tian-xiang |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 王岩 |
WANG Yan |
解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
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| 期刊信息：《中国骨伤》2013年26卷，第4期，第309-313页 |
| DOI：10.3969/j.issn.1003-0034.2013.04.012 |
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目的: 探讨术中CT在重度脊柱侧凸患者后路全椎弓根螺钉手术中的应用价值和临床疗效。
方法: 回顾性分析了2009年6月至2011年6月行全椎弓根螺钉后路治疗的32例重度脊柱侧凸患者, 其中男12例, 女20例;年龄10～38岁, 平均16.8岁;其中19例合并后凸。在术中椎弓根钉置钉完成后应用术中CT扫描多平面重建图像评估螺钉位置并分级, 计算在上胸椎(T1-T4),中胸椎(T5-T8),下胸椎(T9-T12/sub>)和腰椎的螺钉评级结果及螺钉数目(比率),评估为2级和3级的螺钉为误置螺钉。计算术中应用CT次数。测量患者手术前后冠状面Cobb角及合并后凸病例手术前后矢状面后凸Cobb角, 计算侧凸及后凸矫正率。
结果: 32例患者共置入胸腰椎螺钉686枚, 其中胸椎螺钉544枚, 腰椎螺钉142枚, 其中14例患者行截骨手术。经术中CT评估分级, 在上胸椎、中胸椎、下胸椎和腰椎的误置螺钉率分别是5.6%,11.1%,6.7%和4.3%,在胸腰椎总计是7.3%,误置螺钉在术中进行了修正。术中平均应用CT 2.6次(2～4次).术前侧凸Cobb角平均95°( 78°～123°),术后侧凸Cobb角平均为34°( 19°～53°),矫正率为64%;合并后凸病例术前后凸Cobb角69°(46°～82°),术后后凸Cobb角平均为32°( 22°～45°),矫正率为54%.术后有4例患者脑脊液漏, 未发现神经血管损伤病例及手术伤口感染病例。所有病例获得随访, 时间12～26个月, 平均18个月。未发现断钉、断棒、假关节形成等并发症发生。
结论: 在重度脊柱侧凸全椎弓根螺钉后路手术中应用术中CT可及时发现误置螺钉并进行修正, 避免了因螺钉误置导致的二次手术, 保障了手术安全, 手术效果良好。 |
| [关键词]:脊柱侧凸 骨折固定术,内 体层摄影术,X线计算机 |
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| Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws |
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Abstract:
Objective: To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws.
Methods: Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4),middle thoracic vertebra (T5-T8),lower thoracic vertebra (T9-T12/sub>) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated.
Results: There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%,6.7% and 4.3% in upper thoracic vertebra,middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95° (ranged from 78 ° to 123°) and the mean postoperative Cobb angle was 34° (ranged from 19° to 53°). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69° (ranged from 46° to 82 °) and the mean postoperative kyphosis angle was 32° (ranged from 22° to 45°). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection,vascular lesion and nervous lesion were found. All patients had an average18-month follow-up (ranged from12 to 26 months). No broken nails,broken rods and pseudarthrosis were founded.
Conclusion: Application of intraoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery,to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory. |
| KEYWORDS:Scoliosis Fracture fixation,internal Tomography,X-ray computated |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 施新革,张永刚,张雪松,崔庚,毛克亚,王征,董天祥,王岩.术中CT在后路全椎弓根螺钉治疗重度脊柱侧凸中的初步应用[J].中国骨伤,2013,26(4):309~313 |
| 英文格式: | SHI Xin-ge,ZHANG Yong-gang,ZHANG Xue-song,CUI Geng,MAO Ke-ya,WANG Zheng,DONG Tian-xiang,WANG Yan.Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(4):309~313 |
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