特发性脊柱侧凸后路矫形术中个体化选择椎弓根螺钉进钉点的研究

目的探讨脊柱侧凸后路矫形术中椎弓根螺钉的进钉点选择对置钉准确性的影响。方法总结2006年3月～2008年9月手术治疗的27例LenkeⅠ型特发性脊柱侧凸患者，根据术中椎弓根螺钉的进钉点选择方法不同，全部病例可分为标准置钉组（A组）14例和个体化置钉组（B组）13例。术前2组病例的年龄、冠状面Cobb角、T5-T12后凸Cobb角、柔韧性和顶椎旋转度差异无统计学意义（P值〉0．05）。标准置钉组术中均采用文献推荐的进钉点选择方法，而个体化置钉组则根据术前CT预先设计出的进钉点来指导术中的进钉点选择。结果术后2组病例的手术时间、术中出血量、固定节段、Cobb角矫正率和顶椎去旋转率差异均无统计学意义（P值〉0．05）。个体化置钉组的置钉准确率要明显高于标准置钉组（P〈0．01）。结论个体化选择特发性脊柱侧凸患者的椎弓根螺钉进钉点能提高术者的置钉准确率。

Study of individually selection of the entrance point of pedicle screws in the surgery of idiopathic scoliosis

Objective To study the accuracy in placement pediele screws with different method in the selection of entrance point in surgery of scoliosis.Method 27 cases with Lenke Ⅰ type of Adolescent Idiopathic Seoliosis(AIS)from Mar 2006 to September 2008,were retrospectively analyzed.14 eases were randomly divided into standard group(group A)and the entrance point was the same one as described in literatures.13 cases were randomly divided into individually group(group B)and the entran~point wag designed by surgeons on CT scans before surgery.There was no statistical difference in the mean age at time of surgery,Cobb angle on coronal and saggital(T5T12)plane,flexibility and rotational degree of apical vertebra preoperatively between two groups.Result There was no statistical difference in the time of surgery,blood losing,fixation segments,correction rate in Cobb angle and rotational degree of apical vertebra between two groups.The accuracy in placement pedicle screws in individually group was higher than that in control group(P＜0.01).Conclusion The accuracy in placement pedicle screws in the surgery of scoliesis can be improved by individual selection of entrance point.