骨科机器人辅助下脊柱椎弓根螺钉置入准确性与安全性的临床研究

目的:探讨骨科机器人与C形臂X线透视辅助下脊柱椎弓根螺钉置入的准确性与安全性.方法:对2019年1月至2020年8月采用外科治疗的36例脊柱疾患病例进行回顾性分析.36例患者中18例采用骨科机器人辅助下的椎弓根螺钉置入(观察组),男12例,女6例;年龄16～61 (38.44±3.60)岁;青少年脊柱侧弯1例,脊柱结核...     

机器人辅助骶髂贯穿螺钉置入治疗骨盆后环骨折的精确性及临床疗效研究

目的: 探讨骨科手术机器人辅助置入骶髂贯穿螺钉治疗骨盆后环骨折的精准性及临床疗效。方法: 回顾性分析2022年8月至2023年8月行机器人辅助置入骶髂贯穿螺钉治疗的骨盆后环骨折24例患者的临床资料,其中男10例,女14例;年龄21~73(49.29±14.48)岁;骨折按照Tile骨盆分型,B型13例,C型11例。根据术后CT扫描结果采用Gras标准评估螺钉置入效果。末次随访根据Matta评分标准评估骨折愈合情况,采用Majeed评分标准评估功能恢复情况。结果: 24例患者获得随访,时间3~13(6.00±3.28)个月。总计置入骶髂贯穿螺钉36枚,S1贯穿螺钉18枚,S2贯穿螺钉18枚;依据Gras标准,优29枚,良7枚。总螺钉调整次数0.00(0.00,0.75)次。末次随访时Matta评分标准,优18例,良5例,中1例;最大位移距离2.55(0.00,5.65) mm。Majeed评分总分(84.37±8.38)分,优15例,良7例,中2例。结论: 机器人能够精准、安全地辅助完成骶髂关节螺钉置入治疗骨盆后环骨折,促使患者术后功能恢复。     

术中导航校准技术辅助下青少年特发性脊柱侧凸顶椎区置钉精确性研究

【摘要】 目的：比较青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）顶椎区相同椎弓根类型在导航及导航校准技术辅助下置钉的精确性及偏出方向,并分析影响导航置钉偏移的相关因素及导航校准技术的临床意义。方法：回顾性分析自2017年10月～2020年10月,在我院明确诊断为AIS并在导航辅助下行经后路脊柱侧凸矫形内固定术治疗的41例患者,依据术中是否使用导航校准技术,将41例患者分为两组：导航组（n=22）和校准组（n=19）。收集两组患者基本信息,记录两组患者Risser征,术前、术后Cobb角,术后1年时矫形率,根据付长峰椎弓根分型系统对两组患者顶椎区椎弓根分型（A、B、C、D、E型）,依据Rao分型评估两组相同椎弓根类型的置钉精确性。结果：校准组A、B、C型椎弓根优良置钉率（96.4%、87.8%、84.0%）显著高于导航组（79.2%、70.5%、56.7%）,且凹凸双侧0级钉率显著高于导航组,同时校准组B型椎弓根及其凹凸双侧3级钉率（4.1%、2.0%、6.3%）及C型椎弓根凸侧2级钉置钉率（11.1%）显著低于导航组（12.4%、11.1%、13.7%、50.0%）,两组间差异均具有统计学意义（P＜0.05）。此外,校准组A、B、C型椎弓根外侧皮质破壁率（33.3%、33.3%、60.0%）显著低于导航组（64.0%、38.6%、73.1%）,同时校准组A型椎弓根椎体前壁穿破率（0.0%）及C型椎弓根凹侧外侧皮质破壁率（66.7%）显著低于导航组（24.0%、77.8%）,而B型椎弓根内侧皮质穿破率（41.7%）高于导航组（40.9%）,但其凹侧内侧皮质穿破率（36.4%）显著低于导航组（33.3%）,两组间差异均具有统计学意义（P＜0.05）。两组间均未发生脊髓、神经血管损伤等严重并发症。结论：与传统导航相比,导航校准技术在术中能够有效地预防导航偏移,显著提高AIS顶椎区A、B、C型椎弓根置钉精确性,降低误置螺钉外侧壁穿孔率及B型椎弓根凹侧内侧壁穿孔率,提高手术的安全性。     

The invention of an iliosacral screw fixation guide and its preliminary clinical application

Objective: To introduce an iliosacral screw fixation guide and evaluate its efficacy in fixation of sacroiliac joint fracture‐dislocations. Methods: Between January 2011 and May 2011, eight patients (five men, three women) with sacroiliac joint fracture‐dislocation underwent percutaneous iliosacral screw fixation with the assistance of this minimally invasive guide and under CT guidance. The patients, aged from 26 to 56 years (mean 32 years), had vertically unstable pelvic fractures. Before surgery, six patients who had displacement of >2 cm in their sacroiliac joints underwent skeletal traction on the femoral condyle. The inserted sites were marked out on the affected side of their buttocks after the best screw trajectory had been determined under CT control. The gear that controls the direction of the minimally invasive guide was adjusted according to the inserting angle determined by CT scans. A K‐wire was inserted into the sacroiliac joint along the pilot sleeve of the guide, and a hollow screw (diameter 7.3 mm) was implanted into the sacroiliac joint along the K‐wire. Results: All eight operations were successful on the first attempt. The operations lasted from 10 to 20 minutes (mean 14 minutes). Immediate CT scans confirmed that all the screws had been placed in the desired positions, none had penetrated the bones and the configuration of the sacroiliac joints had been satisfactorily restored and firmly fixed. No patient experienced numbness or radiating pain in the lower limbs during surgery. There were no postoperative vascular or neurological complications. Conclusion: The minimally invasive guide can eliminate discrepancies resulting from the surgeon's own sensory input when inserting screws under the guidance of CT, making percutaneous iliosacral screw fixation more accurate, safe and simple.     

Pedicle screw placement in the thoracic spine: a randomized comparison study of computer-assisted navigation and conventional techniques

Objective： To evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques.
Methods： Total 176 thoracic pedicle screws placed in 42 thoracic fracture patients were involved in the study randomly, 20 patients under conventional fluoroscopic control （84 screws） and 22 patients had screw insertion under three dimensional （3D） computer-assisted navigation （92 screws）. The 2 groups were compared for accuracy of screw placement, time for screw insertion by postoperative thincut CT scans and statistical analysis by χ^2 test. The cortical perforations were then graded by 2-mm increments： Grade Ⅰ （good, no cortical perforation）, Grade Ⅱ （screw outside the pedicle 〈2 mm）, Grade Ⅲ （screw outside the pedicle 〉2 mm）.
Results： In computer assisted group, 88 （95.65%） were Grade Ⅰ （good）, 4 （4.35%） were Grade Ⅱ （〈2mm）, no Grade Ⅲ （〉2 mm） violations. In conventional group, there were 14 cortical violations （16.67%）, 70 （83.33%） were Grade Ⅰ （good）, Ⅱ （13.1%） were Grade Ⅱ （〈2 mm）, and 3 （3,57%） were Grade Ⅲ （〉2 mm） violations （P〈0.001）. The number （19.57%） of upper thoracic pedicle screws （ T1-T4 ） inserted under 3D computer-assisted navigation was significantly higher than that （3.57%） by conventional fluoroscopic control （P〈0.001）. Average screw insertion time in conventional group was （4.56 ±1.03） min and （2.54 ± 0.63） min in computer assisted group （P〈0.001）. In the conventional group, one patient had pleura injury and one had a minor dura violation.
Conclusions： This study provides further evidence that 3D computer-assisted navigation placement ofpedicle screws can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly upper thoracic spine.     

CT引导下微创导向器在经皮骶髂关节螺钉固定中的初步应用

 目的 探讨CT引导下微创导向器辅助经皮骶髂关节螺钉固定的准确性。方法 2011年 1月至 5月, 采用 CT引导下微创导向器辅助经皮骶髂关节螺钉固定治疗骶髂关节骨折脱位患者 8例, 男 5例, 女 3例;年龄 26~56岁, 平均 32岁;均为垂直不稳定骨盆骨折。术前对 6例骶髂关节移位超过 2 cm的患者行股骨髁上骨牵引, 牵引重量为体重的 1/8~1/7。在 CT操作台的计算机屏幕上进行定位、测量最佳进针轨道后, 在患侧臀部标记定位。根据 CT扫描确定的进针角度调节导向器角度, 沿导向器前 端套筒打入克氏针, 并顺克氏针拧入 7.3 mm的空心螺钉。结果 8例患者均一次操作成功。手术时间 10~20 min, 平均 14 min。术后即刻行 CT扫描, 确认所有螺钉均位于术前预计的位置并完全位于骨内无 穿出, 骶髂关节形态恢复满意并得到确切固定。所有患者术中均未诉患侧下肢麻木或放射样疼痛, 术后患肢无一例发生血管、神经并发症。结论 导向器可避免 CT引导下骶髂关节螺钉固定时术者仅凭感觉判断进针角度而造成的偏差, 提高了CT引导下骶髂关节螺钉置入的准确性、安全性和简便性。     

标准骶骨侧位像上骶神经根管前缘线对置入骶髂螺钉的作用

目的：了解骶神经根管于S1、S2骶段内的方位、走行,探讨标准骶骨侧位像上骶神经根管前缘线对置入骶髂螺钉的作用.方法：将全骨盆2.0 mm层厚轴向平扫数据导入到Mimics 10.0,并应用其分别将骶骨、双侧无名骨、骶管及骶神经根管制作成3D图像并旋转至标准骶骨侧位及骨盆出入口位后观察骶神经根管的方位、走行.辨识标准骶骨侧位及骨盆出入口位X线片上骶神经根管并观察其特点.结果：在S1、S2骶段内骶神经根管始于同节段椎管的头端前缘的两侧,止于同节段骶前孔,其走行由头端、后方、内侧至尾端、前方、外侧;在X线片上其密度低,尤其在标准骶骨侧位像上常仅其前缘线显像且多有中断现象而需要仔细辨识.结论：在标准骶骨侧位像上辨识骶神经根管前缘线并以之作为骶髂螺钉安全通道的尾后界,则可以避免内置物进入神经根管及骶管,从而提高置钉的安全性.     

数字化导航模板辅助胸椎椎弓根螺钉置钉实验研究

目的探讨数字化导航模板辅助胸椎椎弓根螺钉置入的准确性和可行性。方法将20具尸体胸椎标本随机分为两组,每组10具标本,由同一位具有一定腰椎椎弓根螺钉置钉经验但无胸椎椎弓根螺钉置钉经验的骨外科医师分别采用导航模板法和徒手法进行胸椎椎弓根螺钉的置入手术。术后CT扫描比较两种方法的置钉准确性。结果导航模板法和徒手法各置入240枚螺钉。对两种方法的置钉准确率及风险螺钉发生率进行比较,导航模板法的置钉准确率高于徒手法,风险螺钉发生率低于徒手法,差异有统计学意义（P〈0.05）。徒手法学习曲线明显,导航模板法学习曲线不明显。结论数字化导航模板辅助胸椎椎弓根螺钉置入安全可行,手术操作简单,置钉准确率高,为胸椎椎弓根螺钉置入提供了一种新的方法。     

第三、四骶骨螺钉应用的解剖学研究

目的通过对第三、四骶骨螺钉应用的解剖学测量,探讨第三、四骶骨螺钉应用的安全性。方法 32具成人骶骨标本。设定A点、B点和C点为螺钉进钉点,分别位于相邻骶后孔内侧缘连线的中点,相邻骶后孔连线的中点,经相邻骶后孔连线中点的水平线与骶外侧嵴的交点。D1、D2、D3、α和β、分别为水平面上骶骨内侧置钉,垂直置钉和外侧置钉的钉道长度,内侧置钉和外侧置钉最大偏移角度。d1、d3、θ和φ分别为矢状面上骶骨头侧置钉和尾侧侧置钉钉道长度,头侧置钉和尾侧置钉最大偏移角度。结果 S3螺钉在A和B点进钉,水平面上偏向外侧小于45.21°±10.66°,矢状面上偏向头侧小于8.50°±3.53°;C点进钉,水平面上偏向内侧小于52.00°±7.55°,矢状面上偏向头侧小于19.05°±6.36°。S4螺钉在A和B点进钉,水平面上偏向外侧小于49.50°±9.53°,矢状面上偏向头侧小于12.00°±4.24°,偏向尾侧小于14.00°±2.83°;C点进钉,水平面上偏向内侧小于66.19°±8.14°,矢状面上偏向头侧小于13.50°±3.54°,偏向尾侧小于28.50°±2.12°。结论了解第三、四骶骨的解剖结构和精确的螺钉放置可以保证骶骨螺钉固定成功。     

骶髂关节空心钉内固定导向器的研制及临床应用

目的 自行设计并研制一种骶骼关节空心钉内固定导向器,以期提高S1椎弓根空心钉置入的成功率及置入质量。方法 自行设计并研制的骶髂关节空心钉内固定导向器由带有测量长度的定位器、带有角度刻度表的水平面S1椎弓根空心钉置入角（TSA）、矢状面置入角(SSA)调节器及固定螺丝等组成。2006年6月至2009年10月共收治15例不稳定型骨盆骨折累及骶髂关节者,男6例,女9例;年龄19 ～ 60岁,平均45.6岁。不稳定型骨盆骨折经骶髂关节韧带3例,经骶骨Ⅰ区5例,累及骶骨Ⅱ区5例,累及骶骨Ⅲ区2例。15例患者均采用骶髂关节空心钉内固定导向器引导术中空心钉的操作,共置入18枚空心钉。结果 术后CT及X线片示18枚空心钉置入位置准确,与术前设计相比,具有相同或相近的TSA及SSA。结论 骶骼关节空心钉内固定导向器设计合理,使用方便,能提高S1椎弓根空心钉置入的准确性及置入质量,且可显著减少C型臂X线机的透视次数。     

Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques

Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.     

O型臂联合CT三维导航系统辅助颈椎椎弓根螺钉置入的准确性研究

目的:探讨O型臂联合CT三维导航系统辅助颈椎椎弓根螺钉置钉的准确性,并与侧块螺钉置钉进行比较.方法:回顾性分析2017年3月～2021年2月在我院分别使用O型臂联合CT三维导航系统辅助置入椎弓根螺钉与徒手置入侧块螺钉行颈椎后路内固定术的54例患者,其中男44例,女10例,年龄42～79岁(58.3±9.3岁).根据置钉...     

Accuracy and complications of transpedicular C2 screw placement without the use of spinal navigation

The objective of the study was to describe the technique, accuracy of placement and complications of transpedicular C2 screw fixation without spinal navigation. Patients treated by C2 pedicle screw fixations were identified from the surgical log book of the department. Clinical data were extracted retrospectively from the patients’ charts. Pedicle screw placement accuracy was assessed on postoperative CT scans according to Gertzbein and Robbins (GRGr). A total of 27 patients were included in the study. The mean age of the patients was 56 ± 22.0 years; 51.9% of them were female. As much as 17 patients suffered from trauma, 5 of degenerative disease, 3 of inflammations and 2 of metastatic disease. A total of 47 C2 transpedicular screw fixations were performed. The canulated screws were inserted under visual control following the preparation of the superior surface of the isthmus and of the medial surface of the pedicles of the C2. Intraoperative fluoroscopy was additionally used. The postoperative CT findings showed in 55.3% GRGr 1, in 27.7% GRGr 2, in 10.6% GRGr 3, and in 6.3% GRGr 4 pedicle screw insertion accuracy. Screw insertions GRGr 5 were not observed. Screw malpositioning (i.e., GRGr 3 and 4) was significantly associated with thin (<5 mm) pedicle diameters and with surgery for C2 fractures. In the three patients with screw insertions GRGr 4, postoperative angiographies were performed to exclude vertebral artery affections. In one of these three cases, the screw caused a clinically asymptomatic vertebral artery compression. Hardware failures did not occur. In one patient, postoperative pneumonia resulted in the death of the patient. Careful patient selection and surgical technique is necessary to avoid vertebral artery injury in C2 pedicle screw fixation without spinal navigation. A slight opening of the vertebral artery canal (Gertzbein and Robbins grade ≤3) does not seem to put the artery at risk. However, the high rate of misplaced screws when inserted without spinal navigation, despite the fact that no neurovascular injury occurred, supports the use of spinal navigation in C2 pedicle screw insertions.     

Investigation of bone quality of the first and second sacral segments amongst trauma patients: concerns about iliosacral screw fixation

Background

Iliosacral screw fixation has become a common method for surgical stabilization of acute disruptions of the pelvic ring. Placement of iliosacral screws into the first sacral (S1) body is the preferred method of fixation, but size limitations and sacral dysmorphism may preclude S1 fixation. In these clinical situations, fixation into the second sacral (S2) body has been recommended. The objective of this study was to evaluate the bone quality of the S1 compared to S2 in the described “safe zone” of iliosacral screw fixation in trauma patients.

Materials and methods

The pelvic computed tomography scans of 25 consecutive trauma patients, ages 18–49, at a level 1 trauma center were prospectively analyzed. Hounsfield units, a standardized computed tomography attenuation coefficient, was utilized to measure regional cancellous bone mineral density of the S1 and S2. No change in the clinical protocol or treatment occurred as a consequence of inclusion in this study.

Results

A statically significant difference in bone quality was found when comparing the first and second sacral segment (p = 0.0001). Age, gender, or smoking status did not independently affect bone quality.

Conclusion

In relatively young, otherwise healthy trauma patients there is a statistically significant difference in the bone density of the first sacral segment compared to the second sacral segment. This study highlights the need for future biomechanical studies to investigate whether this difference is clinically relevant. Due to the relative osteopenia in the second sacral segment, which may impact the quality of fixation, we feel this technique should be used with caution.

Level of evidence

III     

骶髂螺钉置入S1椎弓根的形态学研究

目的研究S1椎弓根的形态学特点，探讨经骶髂关节置入S1椎弓根螺钉的可行性。方法测量16具尸体骨盆标本双侧S1椎弓根前后缘的高度、深度(S1椎弓根最狭窄处的宽度)、骶翼深度、骶翼高度。测量骨盆出口位X线片上S1椎弓根的高度，并与肉眼解剖比较。在轴位CT图像上测量髂骨后缘到骶翼、S1椎弓根、S1椎弓根纵轴的距离、髂骨外板与骶椎前缘皮质的距离。观察S1椎弓根矢状切面，评估置入2枚经S1椎弓根骶髂螺钉的安全区。结果椎弓根前后缘的高度平均为30．2mm、26．Imm，椎弓根深度和骶翼深度平均为27．8mm、45．8mm，骶翼后部平均高度为28．7mm。骨盆出口位X线片上S1椎弓根的平均高度是20mm，小于肉眼解剖测量结果(P＜0．0001)。轴位CT图像上，S1椎弓根纵轴在髂骨外板投影点到髂骨后缘的距离平均为32．5mm，到坐骨大切迹最高点的距离平均为38．6mm，髂骨外板到S1椎体前缘皮质的距离平均为105．2mm。结论置入1枚S1椎弓根螺钉是安全的，常规置入2枚椎弓根螺钉可能较困难。     

改良二维X线导航模拟椎体三维影像引导胸腰段椎弓根钉内固定的临床应用

目的探讨改良二维X线导航模拟椎体三维影像的方式在引导胸腰段椎弓根钉内固定的应用效果。方法对66例胸腰段骨折和腰椎疾病患者行后路椎弓根钉固定撑开复位手术,采用改良二维导航的方法获取手术椎节的正侧位及斜位片,虚拟成椎体的正侧位及椎弓根轴位片,引导椎弓根钉植入术。结果术中共植入280枚椎弓根钉,导航虚拟路径与实际椎弓根钉影像之间的平均位置差为1.5mm,角度平均偏差1.0°。术后CT显示,全部椎弓根钉均位于椎弓根内,未出现涉及或突破皮质的现象;椎弓根钉与椎体纵轴角度平均偏差2.0°。结论采用改良二维X线导航模拟椎体三维影像的方法引导胸腰段椎弓根内固定,提高了置钉的准确性和安全性,简便可行,临床效果显著。     

骶髂关节空心钉内固定导向器的研制及临床应用

目的自行设计并研制一种骶骼关节空心钉内固定导向器,以期提高S．椎弓根空心钉置入的成功率及置入质量。方法自行设计并研制的骶髂关节空心钉内固定导向器由带有测长度的定位器、带有角度刻度表的水平面S1椎弓根空心钉置入角（TSA）、矢状面置入角（SSA）调节器及固定螺丝组成。2006年6月至2009年10月共收治15例不稳定型骨盆骨折累及骶髂复合体,男6例,女9例;年龄19-60岁,平均45．6岁。不稳定型骨盆骨折经骶髂关节韧带3例,经骶骨Ⅰ区5例,累及骶骨Ⅱ区5例,累及骶骨Ⅲ区2例。15例患者均采用骶髂关节空心钉内固定导向器引导术中S1椎弓根空心钉的操作,共置入18枚S,椎弓根空心钉。结果术后CT及X线片示18枚S1椎弓根空心钉置入位置准确,与术前设计相比,具有相同或相近的TSA及SSA。结论骶骼关节空心钉内固定导向器设计合理,使用方便,能提高S1椎弓根空心钉置入的准确性,提高置入质量,且可显著减少X线机的透视次数。     

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A ‘Dialog Datastar’ search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.     

徒手置钉技术在脊柱畸形矫正中的准确性与安全性研究

目的 探究徒手置钉技术在脊柱畸形矫正中的准确性与安全性.方法 回顾性分析本院2012年4月-2012年8月所有因脊柱畸形而接受脊柱后路三维矫形椎弓根内固定手术的36名病例.所有病例术中仅采用徒手置钉技术,均不使用C形臂X线机透视或导航系统等计算机辅助设备,较严重病例或重度后凸需要截骨者使用神经电生理监测.术后行脊柱全长正侧位X线片及CT扫描,通过影像归档和通信系统（picture archiving and communication systems,PACS）查看影像资料,记录皮质穿破的类型及距离.术后密切观察有无血管及神经源性并发症直至出院.结果 36名患者置入螺钉总数为550枚.其中210枚螺钉发生误置,总发生率为38.18%（210/550）.内侧皮质穿破（medial cortical perforation,MCP）的发生率为5.27%（29/550）;外侧皮质穿破（lateral cortical perforation,LCP）的发生率为27.09%（149/550）;椎体前壁穿破（anterior cortical perforation,ACP）的发生率为6.55%（36/550）;上终板穿破（endplate perforation,EPP）的发生率为0.55%（3/550）;椎间孔穿破（foramen perforation,FP）的发生率为0.91%（5/550）.上、中、下胸椎及腰椎的MCP发生率分别为3.39%（2/59）、3.90%（51/128）、5.81%（10/172）、6.28%（12/191）,LCP发生率分别为44.07%（26/59）、50.78%（65/128）、25.00%（43/172）、7.85%（15/191）.MCP在胸椎及腰椎的发生率相近,分别为4.7%（17/359）、6.3%（12/191）,差异无统计义意义（P＞0.05）,而胸椎较腰椎更易发生LCP,发生率分别为 37.3%（134/359）、7.9%（15/191）,差异有统计学意义（P＜0.01）.所有病例术后均无神经、血管及内脏相关并发症出现.结论 徒手置钉技术在脊柱畸形矫正中的应用是安全的,可以避免使用术中透视、计算机导航等带来的不利影响.LCP是最常见的穿破类型,在胸椎的发生率比在腰椎高,因而在胸椎使用计算机图像系统等协助置钉可能更有应用价值.