3D打印技术在后路腰椎椎间融合术治疗峡部裂型腰椎滑脱中的应用

目的比较3D打印技术辅助后路腰椎椎间融合术与单纯采用后路腰椎椎间融合术治疗峡部裂型腰椎滑脱的临床疗效。方法回顾性分析自2019-03—2020-04诊治的44例单节段峡部裂型腰椎滑脱症,23例采用3D打印技术辅助后路腰椎椎间融合术治疗(观察组),21例单纯采用后路腰椎椎间融合术治疗(对照组)。比较2组手术时间、术中出血量、术中透视次数、置钉准确率。结果 2组均顺利完成手术并获得随访,随访时间4~7个月,平均6个月。对照组出现1例脑脊液渗漏,对症治疗后治愈。观察组手术时间较对照组短,术中出血量较对照组少,透视次数较对照组少,置钉准确率较对照组高,差异有统计学意义(P<0.05)。结论峡部裂型腰椎滑脱后路腰椎椎间融合术前应用3D打印技术制定手术方案,可以明显提高术中置钉准确率,减少手术时间、术中出血量及术中透视次数。     

峡部裂性腰椎滑脱症的手术治疗进展

峡部裂性腰椎滑脱症是一种常见的脊柱退行性疾病,严重影响人们的生活质量。目前腰椎滑脱的手术治疗指征已基本形成共识,针对该病的手术方案主要是峡部修补、椎管减压、滑脱复位、脊柱融合,治疗原则主要是缓解神经压迫、恢复脊柱稳定,但对于各环节实施的具体方式及程度仍存在较大争议。开放手术能够对严重峡部裂腰椎滑脱进行彻底的减压、复位、融合,重建脊柱的稳定性,但手术创伤过大,而微创手术则可以减少对椎旁软组织的损伤,同时减少术中失血量,缩短术后住院及康复时间,降低术中、术后相关并发症的发生率,因而近年来也受到了越来越多临床医生的推崇,但对于重度峡部裂腰椎滑脱的治疗效果欠佳。现就近年来腰椎滑脱的手术治疗进展做一综述。     

青年战士腰椎峡部裂的分型与治疗

目的:根据青年战士腰椎峡部裂临床特点及影像学表现进行分型,根据不同分型采用不同手术方式,评价治疗效果及并发症。方法:回顾性分析2010年3月～2016年12月期间,我科收治的青年战士腰椎峡部裂患者326例。均为男性,年龄18-36岁,平均22.4±5.1岁。根据临床特点和影像学表现将所有病例分为3型,A型为单纯型峡部裂,无椎间盘突出及腰椎滑脱;B型为峡部裂伴有轻度椎间盘突出或Ⅰ度滑脱,无神经压迫症状及体征;C型为峡部裂合并Ⅰ度或Ⅱ度滑脱并椎间盘突出同时有神经压迫症状及体征。影像学检查:术前均进行腰椎正侧位、左右斜位、站立位全长正侧位X线片,腰椎CT及矢状位重建,腰椎MRI检查。腰椎X线片观察腰椎峡部裂位置及滑脱情况,腰椎CT明确峡部裂的程度及位置。腰椎MRI观察腰椎间盘突出及神经压迫情况。手术方法:A型或B型病例采用椎弓根钉固定,有滑脱进行复位,清理峡部,取髂骨峡部原位植骨。C型病例采用后路椎板减压,椎间盘切除,椎间植骨融合椎弓根螺钉内固定术。术后半年、1年、1年半门诊随访,采用视觉模拟评分(VAS)评价腰痛情况,Oswestry功能障碍指数(ODI)评价功能改善情况。术后半年,1年,1年半,2年及以后进行CT及矢状位重建判断峡部愈合情况。结果:A型和B型病例共305例,C型21例。283例得到随访,通过平均20.0±7.8个月的随访,VAS由术前的平均5.6±1.1分降至终末随访的1.1±0.3分,ODI由术前的平均25.2±3.2分降至末次随访的5.3±1.7分。术后半年复查CT发现,A和B型病例峡部裂愈合252例,愈合率91%(252/278),平均愈合时间12个月,愈合后再次手术取出内固定。椎间植骨病例无需取出内固定。结论:青年战士A、B型腰椎峡部裂病例采用椎弓根螺钉固定,峡部自体髂骨原位植骨融合率高,效果好,C型战士峡部裂则宜采用后路椎间植骨融合椎弓根螺钉内固定术。     

成人轻度峡部裂型腰椎滑脱的治疗分析

目的比较后外侧融合与后外侧融合加椎间植骨融合治疗成人轻度峡部裂型腰椎滑脱的临床及放射学疗效。方法回顾性分析52例成人轻度峡部裂型腰椎滑脱,分别行后外侧植骨融合固定32例(A组),后外侧植骨融合加椎间融合固定20例(B组)。结果患者获随访1~7年,两组术后JOA评分较术前有显著改善,两组融合率比较差别无统计学意义。B组手术时间长、出血量大、并发症多。结论对成人轻度峡部裂型腰椎滑脱采用单纯后外侧植骨融合固定和后外侧融合加椎间融合固定均为有效的治疗方式,两者在临床及影像学有效率方面疗效相当。     

成人腰椎峡部裂型滑脱症的微创治疗

目的 探讨成人腰椎峡部裂型滑脱症的微创外科治疗方法与临床效果.方法 成人峡部裂型腰椎滑脱症患者21例,男12例,女9例;年龄29～73岁,平均51.7岁;L4.5滑脱7例,L5S1滑脱14例;双侧峡部裂19例,单侧2例.根据Meyerding分级:Ⅰ度滑脱13例,Ⅱ度滑脱7例,Ⅲ度滑脱1例.患者全麻,经后路双侧旁中央26 mm切口,在内镜辅助下行单侧或双侧椎管减压、椎间植骨cage融合、新型Sextant-R经皮椎弓根螺钉系统复位与内固定.结果 平均手术时间170 min,平均出血量160 ml,平均卧床时间7.5 d,平均住院时间19 d.20例患者获得随访,随访时间4～32个月,平均12.5个月.术后1年随访17例,患者VAS腰痛评分从术前平均(6.0±2.6)分降至(2.9±2.5)分;VAS腿痛评分从术前平均(6.7±3.3)分降至(2.8±1.6)分;Oswestry功能指数从术前平均44.3%降至27.1%;Nakai分级优良率90%.矢状面X线片腰椎滑脱率从术前35.5%±2.5%降至8.3%±7.5%,滑脱椎的腰前凸角从术前平均11.5°±1.7°增至16.8°±9.5°,椎间隙平均高度从术前(5.4±2.5)mm增至(9.1±3.0)mm.根据Lenke动态X线片评估标准:13例(76%)椎间骨性融合、2例(12%)椎间部分骨性融合、2例(12%)椎间无明显骨性融合.3例发生并发症.结论 内镜辅助下后路腰椎管减压、椎间植骨cage融合及经皮椎弓根螺钉系统复位与内固定治疗成人峡部裂型腰椎滑脱症手术创伤小,近期临床疗效好.     

节段内修复手术治疗腰椎峡部裂及轻度峡部裂性滑脱的疗效分析

目的探讨节段内直接修复手术对于腰椎峡部裂及轻度峡部裂性滑脱的疗效。方法回顾2010-01-2015-06收治并手术治疗的55例腰椎峡部裂及小于Meyerding I°峡部裂性滑脱病例。按术式分为修复组(15例)及融合组(40例),统计各组术前及末次随访时的VAS评分、ODI指数以及腰椎活动度,同时统计各组手术时间及术中出血量以及并发症情况,结果以SPSS 19.0进行相关数据统计分析。结果两组患者一般资料无显著性差异(P0.05),末次随访两组VAS评分及ODI指数均较术前显著改善(P0.05),末次随访两组间VAS评分及ODI指数无显著差异(P0.05),但修复组腰椎活动度大于融合组(P0.05),修复组翻修率明显高于融合组(P0.05)。结论对于单纯腰椎峡部裂及伴轻度滑脱的患者,修复手术与融合手术疗效相当,且其有利于保留腰椎的活动度,但其手术翻修率相对较高。     

MAST Quadrant管道下单侧微创TLIF联合对侧经Wiltse入路置钉治疗腰椎滑脱症

[目的]评价MAST Quadrant管道下经椎间孔腰椎间融合术(transforaminal lumbar interbody fusion,TLIF)联合对侧经Wiltse入路置钉治疗腰椎滑脱症的安全性和有效性。[方法]回顾性分析本院2010年1月²012年4月应用MAST Quadrant管道行单侧微创TLIF联合对侧经Wiltse入路置钉术治疗腰椎滑脱症41例,男12例,女29例;年龄282012年4月应用MAST Quadrant管道行单侧微创TLIF联合对侧经Wiltse入路置钉术治疗腰椎滑脱症41例,男12例,女29例;年龄28⁷6岁,平均(57.85±9.29)岁;其中退变性腰椎滑脱27例,单侧峡部裂性腰椎滑脱6例,双侧峡部裂性腰椎滑脱8例;根据Meyerding滑脱程度分级标准,Ⅰ度滑脱26例,Ⅱ度滑脱15例。记录研究对象的人口统计学资料、手术时间、术中出血量、术后引流量、术后住院天数和并发症,采用日本骨科学会腰痛评分标准(JOA评分)和视觉模拟法(VAS评分)评估临床疗效,影像学评价复位和融合情况。[结果]41例患者均获随访,随访时间1276岁,平均(57.85±9.29)岁;其中退变性腰椎滑脱27例,单侧峡部裂性腰椎滑脱6例,双侧峡部裂性腰椎滑脱8例;根据Meyerding滑脱程度分级标准,Ⅰ度滑脱26例,Ⅱ度滑脱15例。记录研究对象的人口统计学资料、手术时间、术中出血量、术后引流量、术后住院天数和并发症,采用日本骨科学会腰痛评分标准(JOA评分)和视觉模拟法(VAS评分)评估临床疗效,影像学评价复位和融合情况。[结果]41例患者均获随访,随访时间12³9个月,平均(25.95±7.97)个月。平均手术时间(122.19±21.68)min,平均术中出血(163.90±67.85)ml,平均术后引流量(107.76±16.51)ml,术后住院(10.54±1.95)d。术前VAS评分平均(7.07±1.06)分,末次随访时为(2.02±0.79)分,术前后差异有显著性意义(P<0.01);术前JOA评分平均(15.63±2.82)分,末次随访时为(26.54±1.57)分,术前后差异有显著性意义(P<0.01)。术前Tailard指数为(0.34±0.39),末次随访时为(0.15±0.33),差异有统计学意义(P<0.01)。至末次随访时椎间融合率为95.12%(39/41)。1例术后出现伤口感染,1例出现皮下软组织血肿,经清洁换药并静滴抗生素治疗后痊愈;1例术后出现神经根损害表现,腰椎CT明确为椎弓根螺钉位置欠佳激惹神经管所致,经调整钉道并对症处理后痊愈。[结论]MAST Quadrant管道下单侧微创TLIF联合对侧经Wiltse入路置钉是有效治疗腰椎滑脱症的微创手术方式,具有手术创伤小、术后康复快和融合率高等优势。     

成人峡部裂性腰椎滑脱合并椎间盘突出的手术治疗

目的评价自体小关节骨质及Cage后路椎间植骨融合椎弓根内固定治疗成人峡部裂性腰椎滑脱合并椎间盘突出的手术疗效。方法37例峡部裂性腰椎滑脱合并椎间盘突出采用上述方法治疗,平均随访27个月,评价其术前及随访时JOA评分、影像学结果及手术并发症。结果骨性融合率97.30%,优良率94.59%,无严重并发症发生。结论小关节切除、自体小关节骨质及Cage后路椎间植骨融合及椎弓根内固定治疗成人峡部裂性腰椎滑脱合并椎间盘突出有良好的临床疗效。     

经关节突入路椎间融合椎弓根固定治疗峡部裂性腰椎滑脱

目的 评价经关节突入路手术治疗峡部裂性腰椎滑脱的应用价值。方法 2000年 9月 ~2003年 5月我院手术治疗峡部裂性腰椎滑脱患者 83例,随访患者 81例,年龄(55. 25±19. 21)岁,随访时间 (1. 68±0. 93)年。按照不同的手术入路方法分为两组,Ⅰ组经关节突入路,椎间融合椎弓根固定;Ⅱ组经椎板切除入路,椎间融合椎弓根固定。按各组术中的临床出血量、手术时间、术前和术后JOA评分等数据经SPSS11. 5统计软件处理数据。结果　术后采用Stauffer Coventry下腰椎术后疗效评定标准:临床优良率分别为 87%与 75%;术后神经功能改善率分别为 87. 81%与62. 88%。术后均无螺钉松动、断裂或者滑脱加重等并发症,有 3例假关节形成。结论　在峡部裂性腰椎滑脱的患者的手术治疗中,经关节突入路椎间融合椎弓根固定技术具有良好的临床效果。     

多节段腰椎峡部裂的手术治疗

目的探讨多节段腰椎峡部裂伴腰椎滑脱的临床特点及手术治疗方式。方法回顾自1999年3月~2004年12月收治的多节段腰椎峡部裂10例。全部为L4、L5双节段峡部裂,4例伴L5椎体滑脱,6例伴L4椎体滑脱。3例术前没有发现滑脱邻近节段峡部裂。6例行双节段椎弓根螺钉固定和双椎间融合手术,另4例行双节段椎弓根螺钉固定结合滑脱节段椎间融合及邻近节段峡部与后外侧植骨手术。结果随访10~52个月。按Macnab评分标准,优2例,良6例,可2例。放射学检查显示10例腰椎滑脱复位良好,平均椎间高度由术前8.10mm恢复至术后13.11mm。本组未见内固定松动、断裂,无融合器塌陷,无滑脱复发现象。结论多节段腰椎峡部裂临床少见,术前漏诊率较高。对于手术方式的选择要综合考虑脊柱节段稳定性、椎间盘退变程度或突出情况等,结合椎弓根螺钉内固定的后路椎间融合或后外侧融合手术有较好的治疗效果。     

经后路PLIF加BIOFLEX治疗腰椎失稳症

目的 探讨经后路植入椎体间可撑开螺文融合器PLIF及弹性椎弓根内固定系统BIOFLEX对腰椎失稳定症治疗的临床效果.方法 对132例腰椎失稳症患者采用后路椎管及神经根管减压,BIOFLEX椎弓根系统固定并椎间植入PLIF手术治疗.结果 132例术后随访8～23个月,平均15个月,未发现椎间植骨不融合情总,术后优良率97.7%.结论 经后路植入椎体间传统椎间融合术的许多不足,大大减少了术后并发症,提高了腰椎失稳症的治疗效果.     

Hybrid Technique for Posterior Lumbar Interbody Fusion: A Combination of Open Decompression and Percutaneous Pedicle Screw Fixation

The authors describe a hybrid technique that involves a combination of open decompression and posterior lumbar interbody fusion (PLIF) and percutaneously inserted pedicle screws. This technique allows performance of PLIF and decompression via a midline incision and approach without compromising operative time and visualization. Furthermore, compared to standard open decompression, this approach reduces post‐operative wound pain because the small midline incision significantly reduces muscle trauma by obviating the need to dissect the paraspinal muscles off the facet joint complex and by avoiding posterolateral fusion, thus requiring limited lateral muscle dissection off the transverse processes. A series of patients with Grade I‐II spondylolisthesis at L_4–5 and moderate–severe canal/foraminal stenosis underwent midline PLIF at L_4–5, with closure of the midline incision. Percutaneous pedicle screws were inserted, thereby minimizing local muscle trauma, reduction of the spondylolisthesis being performed by using a pedicle screw construct. Rods were inserted percutaneously to link the L₄ and L₅ pedicle screws. Image intensification was used to confirmed satisfactory screw placement and reduction of spondylolisthesis. The results of a prospective study comparing a standard open decompression and fusion technique for spondylolisthesis versus the minimally invasive hybrid technique are discussed. The minimally invasive technique resulted in shorter hospital stay, earlier mobilization and reduced postoperative narcotic usage. The long‐term clinical outcomes were equivalent in the two groups.     

多层螺旋CT三维重建技术辅助脊柱经椎弓根内固定手术

目的研究多层螺旋CT三维重建技术辅助脊柱经椎弓根内固定手术的方法。方法对68例脊柱经椎弓根内固定手术患者行多层螺旋CT薄层扫描后进行容积重建（VR）及多平面重建（MPR）,据此进行辅助诊断、术前计划及个体化测量以指导手术,并在术后评估效果。结果多层螺旋CT三维重建技术辅助下置入椎弓根钉366枚,包括颈椎168枚,胸椎52枚,腰椎146枚。术后复查CT,20枚（5.46%）钉发生超过＂安全区域＂范围的椎弓根穿破,其中颈椎11枚（11/168）发生1～2mm的穿破,1枚（1/168）穿破外侧壁2.2mm,但未出现临床症状,胸椎1枚（1/52）、腰椎7枚（7/146）存在2～4mm的穿破。所有病例术后未发生与置钉相关的脊髓、神经、血管并发症。结论应用多层螺旋CT扫描三维重建辅助脊柱经椎弓根内固定手术,可以量化、个体化确定手术参考指标,提高手术的安全性和准确性。     

腰椎后路椎间植骨融合术的临床比较

目的：比较在腰椎后路椎间植骨融合术手术中是否使用椎弓根螺钉内固定的临床以及影像学结果。方法：本组病人都采用Cloward技术植入了自体髂骨，其中13例进行了椎弓根螺钉内固定，另21例未进行椎弓根螺钉内固定。两组病人的临床和影像学结果进行了比较。结果：固定组77％的病人获得优良疗效，非固定组为81％。固定组的融合率为76．9％，非固定组80．9％。两组中均未发现有植骨块的塌陷。固定组椎间隙高度平均减少了15．3％。非固定组椎间隙高度平均减少了18．4％。两组的临床和影像学结果没有统计学上的明显差异。结论：正确的手术，同时有足够数量和质量的髂骨骨块，可以承受正常生理载负荷，也可以达到很高的融合率。椎弓根系统螺丝钉内固定不必作为PLIF手术的常规以减少植骨块的下陷。     

Thoracic pedicle screw instrumentation using the "Funnel Technique": part 2. Clinical experience

This study is a retrospective review of the clinical results of patients treated with thoracic pedicle screws using the "funnel technique." The objective is to report the clinical results of patients treated with thoracic pedicle screws using the funnel technique for screw placement. A total of 115 patients treated with the use of at least one thoracic pedicle screw were retrospectively identified. All patients were treated at a single medical center, under the senior author's supervision. Twenty-five different residents were responsible for placing 50-60% of these screws, and five different fellows and the senior author placed the remainder. The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing intraoperative and postoperative charts and radiographs. There were 115 patients (age range 9-82 years) with the average follow-up period of 17 months. The total number of screws used was 348; the screw diameter ranged from 4.0 to 7.75 mm. There were no vascular or pulmonary complications. There was no iatrogenic neurologic injury, except for one patient who developed a transient anterior thigh numbness from intraoperative positioning. In fracture patients, 35% (10 of 28) had documented neurologic improvement postoperatively. There were no obviously misplaced pedicle screws on detailed review of intraoperative and postoperative radiographs. No screws had to be electively removed for complications related to misplacement. There were four broken screws, one broken rod, two loose screws, and three connector disengagements. Two patients had deep infections and four patients had pseudarthrosis requiring additional surgery. The clinical results proved that thoracic pedicle screws can be safely placed with the funnel technique.     

二次测量三维CT重建数据在脊柱侧弯矫形术中的应用

目的探讨术前二次测量三维CT重建数据在脊柱侧弯矫形术中的应用和临床意义。方法 2006年8月-2008年3月收治11例重度僵硬型脊柱侧凸患者,男4例,女7例;年龄15～19岁,平均17.2岁。术前在软件操作平台上行二次测量三维CT重建数据,根据测量结果选取入钉点位置,选择合适长度和直径的椎弓根螺钉,按测量角度植入螺钉。共植入197枚螺钉。记录椎弓根螺钉植入时间、术中失血量、术后神经功能状态,测量手术前后矢状面、冠状面Cobb角改变率,术后CT评估螺钉植入的准确性(Andrew分级)。结果椎弓根螺钉植入时间为1～11 min,平均5.8 min;术中失血量为450～2 300 mL,平均1 520 mL。术后1周内复查X线片,冠状面Cobb角矫正率68.5%,矢状面Cobb角矫正率55.5%。术后1周内复查CT扫描显示螺钉位置Ⅰ级77枚(39.1%),Ⅱ级116枚(58.9%),Ⅲ级4枚(2.0%)。11例均获随访,随访时间14个月～2年,无内固定物断裂、移位等并发症以及神经刺激症状发生。结论术前二次测量三维CT重建后的数据为脊柱侧弯患者提供了有效的术中指导,可提高椎弓根植钉准确率和手术安全性。     

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

Cervical pedicle screw fixation is an effective procedure for stabilising an unstable motion segment; however, it has generally been considered too risky due to the potential for injury to neurovascular structures, such as the spinal cord, nerve roots or vertebral arteries. Since 1995, we have treated 144 unstable cervical injury patients with pedicle screws using a fluoroscopy-assisted pedicle axis view technique. The purpose of this study was to investigate the efficacy of this technique in accurately placing pedicle screws to treat unstable cervical injuries, and the ensuing clinical outcomes and complications. The accuracy of pedicle screw placement was postoperatively examined by axial computed tomography scans and oblique radiographs. Solid posterior bony fusion without secondary dislodgement was accomplished in 96% of all cases. Of the 620 cervical pedicle screws inserted, 57 (9.2%) demonstrated screw exposure (<50% of the screw outside the pedicle) and 24 (3.9%) demonstrated pedicle perforation (>50% of the screw outside the pedicle). There was one case in which a probe penetrated a vertebral artery without further complication and one case with transient radiculopathy. Pre- and postoperative tracheotomy was required in 20 (13.9%) of the 144 patients. However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation. The placement of cervical pedicle screws using a fluoroscopy-assisted pedicle axis view technique provided good clinical results and a few complications for unstable cervical injuries, but a careful surgical procedure was needed to safely insert the screws and more improvement in imaging and navigation system is expected.     

Reliability and consequences of intraoperative 3D imaging to control positions of thoracic pedicle screws

Introduction

The insertion of thoracic pedicle screws (T1–T10) is subject to a relevant rate of malplacement. The optimum implantation procedure is still a topic of controversial debate. Currently, a postoperative computed tomography is required to evaluate the screw positions. The present study was undertaken to clarify whether intraoperative 3D imaging is a reliable method of determining the position of thoracic pedicle screws.

Methods

This prospective study involved 40 consecutive patients with thoracic spinal injuries, with intraoperative 3D scans being performed to determine the positions of 240 pedicle screws in T1–T10. The results of the 3D scans were compared with the findings of postoperative CT scans, using a clinical classification system.

Results

The positions of 204 pedicle screws could be viewed by means of both 3D and CT scans and the results compared. The 3D scans achieved a sensitivity of 90.9?% and a specificity of 98.8?%. The rate of misclassification by the 3D scans was 2.5?%. Nine pedicle screws were classified as misplaced and their position corrected intraoperatively (3.8?%). No screws required postoperative revision.

Conclusions

Performing an intraoperative 3D scan enables the position of thoracic pedicle screws to be determined with sufficient accuracy. The rate of revision surgery was reduced to 0?%.     

关节突自体骨移植后路腰椎间盘植骨融合固定术的临床分析

目的探讨关节突自体骨移植后路腰椎间盘植骨融合固定术治疗椎间盘退变的远期疗效。方法自2001年10月至2007年10月本组收治腰椎退变病人50例(平均53.2岁),用这一方法进行椎间融合,平均随访3年。用日本矫形协会标准(JOA)评分:痊愈率、并发症和X线片的结果进行综合的评定。结果关节突自体骨移植后路腰椎间盘植骨融合固定术,椎间融合率(92.0%),临床效果(JOA评定治愈率78.3%),在治疗椎间盘退变、椎体滑脱锥体骨折取得了良好的效果,术后有3个病人出现了并发症。结论关节突自体骨移植后路腰椎间盘植骨融合固定术治疗椎间盘退变疾病手术疗效满意,显著提高融合率,预防神经根管狭窄、神经卡压的发生,减少术后断钉和椎体滑脱复发等问题。     

漏斗技术结合探针技术置入胸椎椎弓根螺钉在脊椎畸形矫形术中的应用

目的 探讨应用漏斗技术结合探针技术置入胸椎椎弓根螺钉在脊椎畸形矫形术中的实用性和安全性。方法 12例脊椎畸形患者接受了后路矫形固定术,在手术矫形过程中,胸椎椎弓根螺钉的置入均采用“漏斗技术结合探针技术”,记录术中和术后并发症;术后常规复查X线片和CT,记录穿出骨皮质螺钉数目及距离。结果 采用“漏斗技术结合探针技术”共置入胸椎椎弓根螺钉129枚,术后复查CT见129枚螺钉中2枚穿透椎弓根内侧壁,3枚螺钉穿破外侧壁;1枚螺钉穿透椎体前壁。Heary分级,其置钉准确性达96.12%。结论 在脊椎畸形矫形术中,应用“漏斗技术结合探针技术”置入胸椎椎弓根螺钉的方法是实用的、安全的。