徒手胸椎椎弓根螺钉置入技术治疗青少年特发性脊柱侧凸的安全性评价

目的 评价徒手胸椎椎弓根螺钉置入技术治疗青少年特发性脊柱侧凸的安全性。方法从2002年7月～2004年6月对38例青少年特发性脊柱侧凸患者，徒手应用胸椎椎弓根螺钉进行后路矫形内固定，所有患者术中进行神经电生理监测及X线透视确认，术后进行X线成像、CAT扫描评估螺钉位置，并对其中35例进行随访，从而评价本技术的安全性。结果共置入胸椎椎弓根螺钉326个，每一水平置入的螺钉数如下：T1,n=2；T2，n=10;T3，n=19；T4，n=27；L，n=28；T6，n=24；T7，n=23；TB，n=25；T9，n=29；T10,n=34；T11,n=48；T12，n=57。通过胸椎CT扫描评价326枚置入畸形胸椎的螺钉位置。共有19枚螺钉（5．8％）有中等程度的皮质穿破，即螺钉的中线在椎弓根壁皮质之外，其中6枚螺钉（1．8％）穿破椎弓根内侧壁。对35例患者进行术后跟踪随访，平均随访时间2年，未发现任何与置入的胸椎椎弓根螺钉（全部326枚螺钉）相关的神经、血管或内脏并发症。结论遵循严格步骤，逐步置入胸椎椎弓根螺钉的徒手技术在治疗青少年特发性脊柱侧凸中具有可靠的安全性。

The evaluation of the safety of free-hand pedicle screw placement in the thoracic spine for adolescent idiopathic scoliosis

Objective To evaluate the safety of free-hand pedicle screw placement in the thoracic spine for adolescent idiopathic scoliosis.MethodsThirty-eight patients of adolescent idiopathic scoliosis underwent posterior stabilization utilizing transpedicular thoracic screws from July 2002 to June 2004.All of the patients got intraoperative neurophysiologic monitoring and were determined by X-ray fluoroscopy.After operation,the positions of inserted screws were evaluated by radiography and computed axial tomography(CAT) and 35 cases got a follow-up so as to evaluate the safety of free-hand technique.(Results)There were 326 thoracic pedicle screws inserted including 2 ones in T_(1),10 in T_(2),19 in T_(3),27 in T_(4),28 in T_(5),24 in T_(6),23 in T_(7),25 in T_(8),29 in T_(9),34 in T_(10),48 in T_(11) and 57 in T_(12),the positions of which were evaluated by CT.Nineteen screws(5.8%) were inserted with moderate cortical perforation equal to that the central line of the screw was out of the cortex of pedicle wall,including 6 screws(1.8%) perforating through the medial wall.After a mean-2-year follow-up in 35 cases,there were no neurological,vascular or visceral complications correlated to the inserted screws.ConclusionThe technique of free-hand thoracic pedicle screw placement performed in stepwise manner is a safe method for treating adolescent idiopathic scoliosis.