| 导向器结合钉道内壁探查法在下颈椎椎弓根螺钉置入中应用研究 |
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投稿时间：2017-06-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 赖必华 |
LAI Bi-hua |
福建医科大学附属南平市第一医院骨科, 福建 南平 353001 |
Department of Orthopaedics, the First Hospital of Nanping City Affiliated to Fujian Medical University, Nanping 353001, Fujian, China |
laibh1976@126.com |
| 吴建斌 |
WU Jian-bin |
福建医科大学附属南平市第一医院骨科, 福建 南平 353001 |
Department of Orthopaedics, the First Hospital of Nanping City Affiliated to Fujian Medical University, Nanping 353001, Fujian, China |
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| 叶宏 |
YE Hong |
福建医科大学附属南平市第一医院骨科, 福建 南平 353001 |
Department of Orthopaedics, the First Hospital of Nanping City Affiliated to Fujian Medical University, Nanping 353001, Fujian, China |
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| 罗森 |
LUO Sen |
福建医科大学附属南平市第一医院影像科, 福建 南平 353001 |
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| 期刊信息：《中国骨伤》2017年，第30卷，第9期，第805-809页 |
| DOI：10.3969/j.issn.1003-0034.2017.09.005 |
| 基金项目:福建省南平市科学技术局资助项目（编号：K2014D15） |
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中文摘要:
目的：探讨导向器结合钉道内壁探查法置入下颈椎弓根螺钉的技巧并评价其准确性及安全性。
方法：2014年1月至2016年10月采用自行设计带角度仪导向器结合钉道内壁探查法对11例患者置入下颈椎椎弓根螺钉，其中男7例，女4例；年龄32～63岁，平均48.1岁；脊髓型颈椎病4例，颈椎骨折脱位4例，无骨折脱位颈脊髓损伤1例，寰枢椎骨折脱位2例。术前CT测量出目标椎弓根直径、理想进钉点及矢状面夹角和横断面内倾角。术中使用自行设计带角度仪导向器严格控制进钉角度，结合探查钉道内壁作为安全置钉标志。术后观察患者有无脊髓及椎动脉损伤表现，复查CT评价椎弓根螺钉位置，并将螺钉准确性进行分级，计算螺钉优良率。
结果：11例患者共置入71枚下颈椎弓根螺钉，均未出现手术所导致的脊髓及神经根损伤症状，亦无椎动脉损伤症状。术后CT评估螺钉位置并进行分级：0级52枚，1级13枚，2级4枚，3级2枚。螺钉位置良好率91%.6枚误置螺钉，内壁穿破4枚，2枚穿破外壁。
结论：钉道内壁探查法置入下颈椎弓根螺钉安全可靠，但有一定的学习曲线。术中探查出钉道内壁及使用角度仪导向器控制进钉角度是置钉关键。 |
| 【关键词】下颈椎椎弓根螺钉 螺钉置入 导向器 钉道内壁探查 |
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| Application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement |
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ABSTRACT
Objective: To investigate the skill and evaluate the accuracy for application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement.
Methods: Subaxial cervical pedicle screw was inserted in 11 patients by the guide combined with probing the internal wall of pedicle screw trajectory from January 2014 to October 2016,including 7 males and 4 females with an average age of 48.1 years(ranged 32 to 63 years). There were 4 cases with cervical spondylotic myelopathy,4 with fracture and dislocation of cervical vertebrae,1 with cervical cord injury without fracture and dislocation,and 2 with atlantoaxialfracture and dislocation. The target pedicle's diameter,optimal entry point,sagittal angle and cross-sectional angle were measured by CT before operation. During operation,the pedicle screw inserted angle was controlled by a guide with a self-designed protractor and probed the internal wall of pedicle screw trajectory as medial safety margin of insertion screw. The accuracy of cervical pedicle screw was evaluated by CT with classification of four grades and assessed whether there was injury of spine cord or vertebral artery postoperatively.
Results: Seventy-one cervical pedicle screws were placed among 11 patients,and no one had been found with clinical manifestations of injury of spine cord (or nerve root) or vertebral artery after operation. According to postoperative CT scan for evaluating the grade of screw position,52 screws were in grade 0,13 in grade 1,4 in grade 2,2 in grade 3,and 91% (65/71) located in good position. In total,6 screws were incorreted in placement,and 4 cases of them broke medial wall and 2 cases broke lateral wall.
Conclusion: The method of probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement is safe and reliable,but the studying curve is long. Probing the internal wall of pedicle screw trajectory and controlling the insertion angle by guide with a protractor are key points of this technology. |
| KEY WORDS Subaxial cervical pedicle screw Screw placement Guide Probing the internal wall of pedicle screw trajectory |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赖必华,吴建斌,叶宏,罗森.导向器结合钉道内壁探查法在下颈椎椎弓根螺钉置入中应用研究[J].中国骨伤,2017,30(9):805~809 |
| 英文格式: | LAI Bi-hua,WU Jian-bin,YE Hong,LUO Sen.Application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(9):805~809 |
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