| 李明,许明,刘洋,朱晓东,宋元进,张琪,顾苏熙.徒手胸椎椎弓根螺钉置入技术治疗青少年特发性脊柱侧凸的安全性评价[J].脊柱外科杂志,2005,3(4):193-198. |
徒手胸椎椎弓根螺钉置入技术治疗青少年特发性脊柱侧凸的安全性评价  点此下载全文 (Fulltext) |
| 李明 许明 刘洋 朱晓东 宋元进 张琪 顾苏熙 |
| 200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科;200433 上海, 第二军医大学附属长海医院骨科 |
| 基金项目：军队“十五”科研基金资助项目（01MA149）；国家自然科学基金资助项目（024119027） |
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| 摘要： |
| 目的 评价徒手胸椎椎弓根螺钉置入技术治疗青少年特发性脊柱侧凸的安全性。方法 从2002年7月~ 2004年6月对38例青少年特发性脊柱侧凸患者，徒手应用胸椎椎弓根螺钉进行后路矫形内固定，所有患者术中进行神经电生理监测及X线透视确认，术后进行X线成像、CAT扫描评估螺钉位置，并对其中35例进行随访，从而评价本技术的安全性。结果 共置入胸椎椎弓根螺钉326个，每一水平置入的螺钉数如下：T1，n=2；T2，n=10；T3，n=19；T4，n=27；T5，n=28；T6，n=24；T7，n=23；T8，n=25；T9，n=29；T10，n=34；T11，n=48；T12，n=57。通过胸椎CT扫描评价326枚置入畸形胸椎的螺钉位置。共有19枚螺钉（5.8%）有中等程度的皮质穿破，即螺钉的中线在椎弓根壁皮质之外，其中6枚螺钉（1.8%）穿破椎弓根内侧壁。对35例患者进行术后跟踪随访，平均随访时间2年，未发现任何与置入的胸椎椎弓根螺钉（全部326枚螺钉）相关的神经、血管或内脏并发症。结论 遵循严格步骤，逐步置入胸椎椎弓根螺钉的徒手技术在治疗青少年特发性脊柱侧凸中具有可靠的安全性。 |
| 关键词：脊柱侧凸 胸椎 内固定器 青少年 徒手技术 椎弓根螺钉 |
| The evaluation of the safety of free-hand pedicle screw placement in the thoracic spine for adolescent idiopathic scoliosis Fulltext |
| LI Ming XU Ming LIU Yang |
| Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China;Department of Orthopaedics, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China |
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| Abstract: |
| Objective To evaluate the safety of free-hand pedicle screw placement in the thoracic spine for adolescent idiopathic scoliosis. Methods Thirty-eight patients of adolescent idiopathic scoliosis underwent posterior stabilization utilizing transpedicular thoracic screws from July 2002 to June 2004. All of the patients got intraoperative neurophysiologic monitoring and were determined by X-ray fluoroscopy. After operation,the positions of inserted screws were evaluated by radiography and computed axial tomography (CAT) and 35 cases got a follow-up so as to evaluate the safety of free-hand technique. Results There were 326 thoracic pedicle screws inserted including 2 ones in T1,10 in T2, 19 in T3, 27 in T4, 28 in T5, 24 in T6, 23 in T7, 25 in T8, 29 in T9, 34 in T10, 48 in T11 and 57 in T12, the positions of which were evaluated by CT. Nineteen screws (5.8%) were inserted with moderate cortical perforation equal to that the central line of the screw was out of the cortex of pedicle wall, including 6 screws (1.8%) perforating through the medial wall. After a mean-2-year follow-up in 35 cases, there were no neurological, vascular or visceral complications correlated to the inserted screws. Conclusion The technique of free-hand thoracic pedicle screw placement performed in stepwise manner is a safe method for treating adolescent idiopathic scoliosis. |
| Keywords:scoliosis thoracic vertebrae internal fixators adolescent free-hand technique pedicle screws |
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