中国骨伤2017，Vol.30Issue(9)：805-809,5.DOI:10.3969/j.issn.1003-0034.2017.09.005
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
Application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement
摘要
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 in-serted 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 posi-tion,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 reli-able,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.关键词
下颈椎椎弓根螺钉/螺钉置入/导向器/钉道内壁探查Key words
Subaxial cervical pedicle screw/Screw placement/Guide/Probing the internal wall of pedicle screw trajectory引用本文复制引用
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):805-809,5.基金项目
福建省南平市科学技术局资助项目(编号:K2014D15) Supported by Bureau of Science and Technology of Nanping City of Fujian Province (No.K2014D15) （编号:K2014D15）
