青少年特发性脊柱侧凸应用Ball tip技术置入椎弓根钉的准确性

目的针对需要手术治疗的青少年特发性脊柱侧凸,通过与传统徒手置钉技术比较来评价一种新的椎弓根置钉技术—Ball tip技术置入椎弓根钉的准确性。方法自2009年5月~2011年5月,对28例青少年特发性脊柱侧凸,术中应用椎弓根球形探针(ball tip probe)置入椎弓根。结果采用Ball tip技术共置入193枚椎弓根钉,传统徒手技术置入161枚螺钉。术后CT扫描显示Ball tip组椎弓根钉钉道准确率为89.1%,共有21枚(10.9%)置钉不良螺钉,其中5枚(2.6%)穿透椎弓根内侧骨皮质,16枚(8.3%)穿透外侧骨皮质。徒手置钉组准确率为75.2%,共有40枚(24.8%)置钉不良螺钉,其中11枚(6.8%)穿透椎弓根内侧骨皮质,29枚(18.0%)穿透外侧骨皮质。两组置钉准确率的差异具有统计学意义(P<0.01),两组螺钉穿透椎弓根内侧、外侧骨皮质的差异具有统计学意义(P<0.05)。结论与传统徒手置钉技术相比,椎弓根Ball tip技术,可准确地置入椎弓根钉,减少因螺钉误置所导致的术后并发症。

Accuracy of ball tip technique for pedicle screw placement in patients with adolescent idiopathic scoliosis

Objective To evaluate the efficacy of the ball tip technique in placing pedicle screws in patients with adolescent idiopathic scoliosis,as compared with the conventional freehand technique.Methods From May 2009 to May 2011,the ball tip technique in pedicle screw placement was used in 28 patients with adolescent idiopathic scoliosis.Results All of 193 screws were evaluated in the ball tip group and 161 in the conventional freehand group.There’re 172 screws(89.1%) were recognized as intrapedicular position in the ball tip group and 121(75.2%) in the conventional group.A significant difference in the accuracy of pedicle screw placement was observed between the two groups(P <0.01).In the ball tip group,5 screws(2.6%) were classified as breaches of inner cortex of pedicle,16(8.3%) as breaches of outer cortex of pedicle.In the conventional group,11 screws(6.8%) were classified as breaches of inner cortex of pedicle,29(18.0%) as breaches of outer cortex of pedicle.A significant difference in the percentage of pedicle screws classified as pedicle breaches was determined between the two groups(P <0.05).Conclusion The ball tip technique enhances the accuracy of pedicle screw placement as compared with the conventional freehand technique.This technique can probably reduce the risk of complications from screw misplacements.