徒手胸椎椎弓根螺钉置入术在青少年脊柱侧凸患者中的临床应用

目的探讨徒手胸椎椎弓根螺钉置人技术治疗青少年脊柱侧凸的方法及安全性。方法从2006年11月至2009年1月对31例青少年脊柱侧凸患者行矫形手术，术前均对畸形脊柱进行CT加密扫描．测量进钉点至椎体前缘的深度、进针角度、椎弓根直径和椎体的旋转角度．根据测得数据确定椎弓根螺钉置人的深度和方向．徒手应用全椎弓根螺钉棒系统进行后路矫形内固定手术，所有患者术后进行X线成像、CT扫描评估螺钉位置，并对其进行随访。从而评价本技术的准确性安全性。结果共置入胸椎椎弓根螺钉149个，通过胸椎CT扫描评价149枚置入畸形胸椎的螺钉位置。共有8枚螺钉（5％）有中等程度皮质穿破，即螺钉部分在椎弓根壁皮质之外．没有相应神经症状。术后跟踪随访，平均随访时间12．7个月，未发现任何与置入的胸椎椎弓根螺钉相关的神经、血管或内脏并发症。结论严格遵循步骤，逐步置入胸椎椎弓根螺钉的徒手技术在治疗青少年脊柱侧凸中具有可靠的安全性。熟悉解剖并结合CT扫描．术前准确测量对手术成功非常重要。

The application of free-land pedicle screw placement in the thoracic spice for adolescent idiopathic scoliosis

Objective To investigate the safety and method of free-hand pedicle screw placement in the thoracic spine for adolescent idiopathic scoliosis. Methods Thirty-one patients of adolescent idiopathic scoliosis underwent posterior stabilization utilizing transpedicular thoracic screws from November 2006 to January 2009.On the basis of imaging of thoracic vertebral pedicles in 31 cases of adolescent scoliosis, the screw prick point, angle, depth, diameter of vertebral pedicle and rotative angle of vertebra（VRA）mere measured and defined on the thoracic vertebrae pedicle by CT thin-slice scan in all cases.The accuracy and safety of free-hand technique were evaluated with spine X-ray and CT thin- slice scan in all cases postoperatively.Results There were 149 thoracic pedicle screws inserted, the positions of which were evaluated by CT 8 screws （5%） were inserted with moderate cortical perforation equal to that the central line of the screw was out of the cortex of pedicle wall. After a mean 12.7-year follow-up in all 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. There should be gain a satisfactory effect with familiar with pedicular anatomy of scoliosis and imaging examination.