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1、全椎弓根螺钉系统矫正特发性脊柱侧凸 探讨胸椎椎弓根螺钉的植入方法，总结钉棒系统矫正脊柱侧凸的效果。方法咬除进钉点骨皮质，以据术前测量的深度和旋转的程度，分别先后用1.5 mm、2.5 mm克氏针沿椎弓根方向钻孔，如阻力加大、克氏针弯曲，说明遇到骨皮质，调整进针方向。达到测定的深度停止进针，球形探子探查无误后改用锤子将导锥顺着制造的钉道小心缓慢击入，深度一致后，再次用球形探子探查，植入螺钉。结果胸椎椎弓根螺钉一次性植入成功率胸段97（600619），腰段99%（733/740）。术后未出现脊髓损伤和神经功能障碍，无切口感染。术后冠状面平均矫正率73。矢状面后凸Cobbs角（T1T12）630，平
2、均23。旋转畸形矫正度。103例平均随访4.9年，躯干平衡良好，无平背畸形，植骨融合良好，末次随访冠状面角度丢失率平均为3.7，迟发性感染1例，螺钉断裂2例，均行内固定取出。结论克氏针制备螺钉钉道，是胸椎椎弓根螺钉植入的较好方法。钉棒结构具有良好的三维矫正控制力。全椎弓根螺钉系统矫正特发性脊柱侧凸效果良好。胸椎 脊柱侧凸 椎弓根螺钉 徒手技术 矫正手术Abstract：ObjectiveTo discuss the methods of insertion the pedicle screws of thoracic vertebrae and sum the results of corre
3、ction of idiopathic scoliosis.MethodBone of entrance was removed with rongeur forceps.According to the depth and rotation preoperative,to drill using 1.5 mm and 2.5 mm Kirschner wire.If the resistance was increasing and Kirschner wire was bending,it needs to adjust the direction.Stop to drill whenac
4、hieve the depth,after checking the hole using special probe then strike awl in the hole.Checking the hole using specillum again then insert the screws.Result97% were successful inserted by one time.There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of
5、incisionsl wound.The correction rate in coronal plane was 73% after surgery.The Cobbs angle in sagittal plane was from 6 to 30,with average of 23.Rotation deformity was corrected to degree.There were 103 patients.Followup duration was with average 4.9 years.Trunk balance was good and no flat back wa
6、s happen.Bone graft fused well.The correction lost 3.7% in coronal plane at final follow up.One case was with late infection and 2 patients were with screws broken.The internal fixations were removed out.ConclusionUsing Kirschner wire to made screw hole is a good way to insert thoracic vertebrace pe
7、dicle screw.Screwrod system had favourable three diamensions correct control force.Fully pedicle screw to correct idiopathic scoliosis has good results.Key words:thoracic vertebrae;scolisis;pedicle screw;freehand;correction20世纪80年代Dubousset提出脊柱侧凸三维矫形的理论，椎弓根螺钉系统矫正脊柱侧凸已广泛应用于临床1、2，随着胸椎椎弓根解剖形态的深入研究，准确的植
8、入胸椎椎弓根螺钉矫正脊柱侧凸已显出明显的优势。1998年1月2005年1月采用全椎弓根螺钉矫正特发性脊柱侧凸138例，效果满意。1资料与方法1.1一般资料本组138例，男52例，女86例；年龄1319岁，平均15.3岁。术前冠状面Cobbs角41107，平均65.2。矢状面后凸角（T1T12）-961，平均43.7。旋转畸形（NashMoe法）为度。King分型：型14例，型49例，型41例，型23例，型11例。主弯右侧凸105例，左侧凸23例。应用椎弓根螺钉1 359枚，其中胸椎椎弓根螺钉619枚，最高达T2椎弓根水平。1.2手术方法所有患者取后入路，骨膜下剥离椎旁肌肉组织，胸椎达肋横突外缘
9、，腰椎达副横突外缘。腰椎人字嵴顶点为进钉点；胸椎关节突表面外缘的纵线与肋横突中上13横线的交点为进钉点，同时参考胸椎椎弓根CT片以及X线片，三维CT重建。用尖嘴咬骨钳咬除胸椎椎弓根进钉点骨皮质，分别先后用1.5 mm和2.5 mm克氏针沿椎弓根方向钻孔，深度由术前X线片、CT片测量的数据控制，球形探子探查后，用锤子将导锥顺着前面制造的钉道小心击入，再次球形探子探查，测量深度，置入适当长度的椎弓根螺钉3。将预弯后的连接棒依次放入各椎弓根螺钉尾端开口内，拧入螺钉防止连接棒脱出。逐渐旋转连接棒，随着棒体旋转，畸形得到矫正。根据侧凸类型不同，棒体旋转方向不同。在胸段侧凸时，连接棒由凸侧向凹侧旋转，即：
10、将胸椎冠状面侧凸转变为矢状面后凸。腰段侧凸时，连接棒由凹侧向凸侧旋转，即：将腰椎的冠状面侧凸转变为矢状面前凸。胸腰椎双弯时，将连接棒向同一方向旋转，即：胸椎由凸侧向凹侧旋转，同时腰椎由凹侧向凸侧旋转，可同时矫正胸腰椎双弯畸形并部分恢复胸腰椎矢状面弯曲。再用撑开钳局部撑开矫正残余侧凸畸形。为增加固定强度，在凹侧固定器安装及矫正完毕后，于畸形凸侧安装另一组连接棒，2根连接棒之间固定12组横向连接器，使整个装置成为1个框架结构。对重度或僵硬的脊柱侧凸，可采用分期矫正，即：一期行脊柱前路或后路松解，头颅骨盆环牵引，待牵引至脊髓耐受极限时，二期行椎弓根螺钉器械矫正、脊柱植骨融合。伴有严重剃刀背畸形患者，同期一个切口切除35条肋骨，处理植骨床，用自体髂骨加异体骨植骨融合。支具固定4个月。
全椎弓根螺钉系统矫正特发性脊柱侧凸
