目的 探讨椎板螺钉在胸椎内固定中的临床应用。方法 选择2017-04至2020-06采用胸椎椎板螺钉治疗胸椎疾病的患者8例,男5例,女3例,年龄37~59岁,平均43.2岁,其中胸椎霉菌性脊柱炎1例,胸椎大肠杆菌感染1例,胸椎骨折翻修术2例,颈椎骨折行颈胸段固定2例,术中椎弓根崩裂改用椎板螺钉2例。手术均在全身麻醉下进行,术后行胸椎CT检查,观察螺钉固定情况,术后3、6、12个月,复查胸椎CT观察螺钉是否有松动、移位。术前,术后3、6、12个月随访X线测量胸椎Cobb角,疼痛视觉模拟评分(VAS)和Oswesty功能障碍指数(ODI)。结果 8例患者,32枚椎板螺钉,平均随访(14.3±2.3)个月,椎板螺钉无松动、拔出、断裂,术前、术后、随访Cobb角变化无统计学意义。术后12个月时ODI指数为(20.3%±1.2%),较术前(79.9%±1.7%)明显降低(t=28.8,P＜0.01);术后12个月时VAS评分(0.8±0.2)较术前(6.7±0.4)明显降低(t=12.3,P＜0.01)。结论 在无法置入胸椎椎弓根螺钉的情况下,采用椎板螺钉固定,有同样牢固的固定效果。
Abstract
Objective To investigate the clinical application of lamina screw in thoracic internal fixation.Methods A total of 8 thoracic spine disease patients (aged 37 to 59) who were treated with thoracic pedicle screws between April 2017 and June 2020 were prospectively included. The mean age was 43.2 years old. Of these participants, included 1 case of thoracic mycospondylitis, 1 case of thoracic Escherichia coli infection, 2 cases of thoracic facture revision, 2 cases of cervical fracture CT performed cervicothoracic fixation, and 2 cases of intraoperative pediclerupture were treated with lamina screw. All operations were performed under general anesthesia. Postoperative thoracic vertebral CT was performed to observe screw fixation, and at 3, 6, and 12 months after surgery, thoracic spine CT was reviewed to observe whether screws were loosenedorshifted. Thoracic Cobb angle, the VAS pain score and oswesty disability index (ODI) were measured preoperatively and postoperative 3, 6, and 12 months.Results There were 8 patients (32 laminar screws) followed with mean follow-up of (14.3±2.3) months. All screws were not loosened, pullout or fractured. At final follow-up, there was no statistically significant change in Cobb angle. The postoperative ODI (20.3%±1.2%) was significantly (t=28.8,P<0.01) lower than that before operation (79.9%±1.7%). The VAS pain score at 12 months after surgery (0.8±0.2) was significantly (t=12.3, P<0.01) lower than that before surgery (6.7±0.4).Conclusions In cases where thoracic pedicle screws cannot be placed, laminar screws are used to fix the spine with equal firmness.
关键词
椎板螺钉 /
椎弓根螺钉 /
胸椎板螺钉 /
胸椎翻修术
Key words
lamina screw /
pedicle screws /
thoracic lamina screw /
thoracic revision
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