漏斗技术在上胸椎置人椎弓根螺钉中的应用

目的 评价应用漏斗技术置入上胸椎(T1～T5)椎弓根螺钉的安全性并探讨其置钉方法.方法 回顾性分析2006年3月至2010年10月间行椎弓根螺钉固定涉及上胸椎(T1～T5)且获得随访的病例共105例,男57例,女48例,年龄14～ 65岁,平均40.3岁,其中采用漏斗技术置钉的共54例患者(设为A组),采用徒手法置钉的共51例患者(设为B组).记录术中和术后出现的血管、神经、内脏损伤等并发症;术后行CT扫描,评价螺钉的位置,记录所有穿透骨皮质螺钉的数目和距离;比较分析A、B两组间及不同节段间椎弓根螺钉的不良置钉率.结果 105例患者在上胸椎(T1 ～T5)共置入椎弓根螺钉402枚,术中13枚椎弓根发生骨折,4例患者术中出现硬膜撕裂,所有患者末出现大血管、脊髓及肺部损伤相关并发症.术后CT扫描证实45枚螺钉穿破椎弓根皮质(不良置钉率11.2％),其中A组不良置钉率为10.14％,组内不同节段间不良置钉率差异无统计学意义(x2 =0.48,P=0.98);B组不良置钉率为12.31％,组内不同节段间不良置钉率也差异无统计学意义(,=2.55,P=0.64).两组间比较不良置钉率差异无统计学意义(x2 =0.47,P=0.49).25枚穿破椎体外侧壁,17枚穿破椎体内侧壁,3枚穿破椎体前壁.59例术前合并神经功能损害的患者,术后37例神经功能得到1～3级改善.结论 在上胸椎采用漏斗技术行胸椎椎弓根螺钉置入是安全、可靠的.

Safety evaluation of pedicle screw placement in proximal thoracic vertebrae via funnel technique

Objective To evaluate the safety of funnel technique for the placement of proximal thoracic pedicle screws (T1 -T5 ).Methods Between March 2006 and October 2010,105 patients undergoing pedicle screw placement of proximal thoracic vertebrae were retrospectively reviewed.There were 57 males and 48 females with an average age of 40.3 years old.According to the techniques of placing pedicle screws,they were classified into the funnel technique group ( group A,n =54) and bare hand technique group (group B,n =51 ).Their perioperative and postoperative complications were examined simultaneously.Postoperative CT (computed tomography) scans were performed in all cases to determine the instrument malposition.The percentage of malposition was analyzed between two groups and among different levels.Results A total of 402 proximal thoracic pedicle screws were placed in 105 cases.No injuries of spinal cord,large blood vessels or lung were reported.There were 13 intraoperative pedicle fractures and 4 dural tears.A total of 45 screws were misplaced in 105 patients (11.19％).In group A,the percentage of malposition was 10.14％.And there were no statistic significance among different levels ( P ＞ 0.05 ).In group B,the percentage of malposition was 12.31％ and no statistic significance existed among different levels ( P ＞ 0.05 ).No intra-group statistical significance was found for group A or B.Medial malposition was found in 17 cases.And lateral malposition occurred in 25 screws while only 3 screws penetrated anterior cortex.Among 59 patients with neurological deficits,37 cases showed postoperative improvements according to the AISA ( American Spinal Injury Association) scale.Conclusion The funnel technique is both safe and reliable for the placements of proximal thoracic pedicle screws.