中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (39): 7303-7306.doi: 10.3969/j.issn.1673-8225.2011.39.021

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

中上胸椎后路半椎弓根入路置钉固定技术的临床应用

杨永军,周纪平,姚树强,姜传杰,于建林,杨  凯,谭远超   

  1. 山东省文登整骨医院,山东省威海市  264400
  • 收稿日期:2011-05-31 修回日期:2011-08-04 出版日期:2011-09-24
  • 通讯作者: 周纪平,主治医师,山东省文登整骨医院脊柱脊髓一科,山东省威海市264400 abcdzhoujiping@163.com
  • 作者简介:杨永军★,男,1966年生,山东省临沂市蒙阴县人,汉族,硕士,副主任医师,主要从事脊柱脊髓外科研究。
  • 基金资助:

    威海市科技发展计划项目(2009-3-89-4),课题名称:中上胸椎后路半椎弓根入路置钉固定技术的基础研究与临床应用。

Clinical application of middle-upper thoracic semi-pedicular fixation via a posterior approach

Yang Yong-jun, Zhou Ji-ping, Yao Shu-qiang, Jiang Chuan-jie, Yu Jian-lin, Yang Kai, Tan Yuan-chao   

  1. Orthopedic Hospital of Wendeng, Weihai  264400, Shandong Province, China
  • Received:2011-05-31 Revised:2011-08-04 Online:2011-09-24
  • Contact: Zhou Ji-ping, Attending physician, Orthopedic Hospital of Wendeng, Weihai 264400, Shandong Province, China abcdzhoujiping@163.com
  • About author:Yang Yong-jun★, Master, Associate chief physician, Orthopedic Hospital of Wendeng, Weihai 264400, Shandong Province, China
  • Supported by:

    Science and Technology Development Research Project of Weihai City, No. 2009-3-89-4*

摘要:

背景:中上胸椎矫形固定以椎弓根钉置入内固定三维稳定性最佳,效果最好,但由于胸椎椎弓根解剖上较腰椎窄细,且胸椎管内是脊髓,内固定的难度和风险较高。
目的:分析中上胸椎后路半椎弓根入路置钉固定技术的临床应用效果。
方法:应用后路半椎弓根入路置钉固定治疗中上胸椎疾病患者58例,在T1~T2可应用直径4.5 mm、长度30 mm的螺钉,T3~T8应用直径5.0~6.0 mm、长度35~40 mm的螺钉,螺钉直径均在4.5 mm以上。
结果与结论:置钉固定后胸椎X射线片及CT显示,无螺钉进入椎管内,脊柱序列恢复良好,无内固定松动及断钉等并发症发生;置钉后无脊髓损伤加重及感染等并发症。患者生活完全恢复,疼痛消失16例;不全性和完全性截瘫46例日常生活能够自理,胸背部疼痛消失,无后凸畸形。表明中上胸椎半椎弓根入路置钉技术选用较粗、较长螺钉置入内固定效果可靠,安全,且进钉技术相对简单,易于掌握,可作为中上胸椎后路内固定的良好选择。

关键词: 中上胸椎, 半椎弓根入路, 置钉, 固定, 临床应用

Abstract:

BACKGROUND: The three-dimensional stability of middle-upper thoracic pedicle screw fixation is the best. But because of narrow and thin thoracic pedicle and spinal cord within the thoracic spinal canal, it is of high difficulty and risk for this internal fixation.
OBJECTIVE: To explore the clinical effects of middle-upper thoracic semi-pedicular fixation via a posterior approach.
METHODS: Fifty-eight patients with upper thoracic diseases were treated with middle-upper thoracic semi-pedicular fixation via a posterior approach. Screws of 4.5 mm in diameter and 30 mm in length were used at T1-2, and screws of 5.0-6.0 mm in diameter and 35-40 mm in length used at T3-8.
RESULTS AND CONCLUSION: Postoperative thoracic X-ray films and CT showed no screws entered the spinal canal, and spinal sequence recovered well, without internal fixation loosening and breakage and other complications. There was no spinal cord injury, infection and other complications. All the patients recovered normal life, and pain disappeared in 16 cases. Forty-six patients with incomplete and complete paraplegia could take care of themselves, chest and back pain disappeared, and no kyphosis occurred. The middle-upper thoracic semi-pedicular fixation via a posterior approach is reliable, safe and easy, which can be used as a good choice for middle-upper thoracic posterior fixation.

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