摘要
青少年特发性脊柱侧凸是一种病因不明且发病率较高的脊柱畸形,尤其好发于青春期女性。侧凸患者若早期得不到有效治疗,随着年龄增长或短时间发育过快侧凸程度会持续加重,逐渐出现高低肩、剃刀背等外观畸形,严重者可影响心肺功能甚至缩短预期寿命,对患者的身心健康造成极大影响。轻度的脊柱侧凸常常经支具治疗后可以得到很好的控制,中重度以上的侧凸畸形往往需要侧凸矫形手术治疗。在青少年特发性脊柱侧凸矫形术中,与传统的钩锥内固定器械相比,椎弓根螺钉具备更好的稳定性与坚固性,且矫形力更强,器械所致的相关并发症发生率更低。与此同时,侧凸患者存在椎体左右发育不平衡、凹侧椎弓根直径较窄、顶椎区域形成不同程度的旋转,造成椎管内脊髓与胸主动脉等重要解剖结构位置发生变化,对椎弓根螺钉的置入增加困难造成较高的误置率。如何提高置钉的安全性减少螺钉误置率,降低损伤脊髓、神经根、血管、内脏等风险,一直是脊柱外科医师关注的热点。本文通过总结青少年特发性脊柱侧凸患者的椎弓根解剖结构、置钉并发症与计算机导航、3D导向模板等新技术对置钉精度影响的相关文献,对置钉安全性进行综述,希望能为临床实践提供参考。
Adolescent idiopathic scoliosis is a spinal deformity with unknown etiology and high incidence,especially in ad⁃olescent females.If scoliosis patients do not get effective treatment in the early stage,the degree of scoliosis will continue to wors⁃en with the growth of age or the rapid development of scoliosis in a short time,and the appearance deformities such as high and low shoulders and razor back will gradually appear,which can affect the cardiopulmonary function and even shorten life expectan⁃cy.It has a great impact on the physical and mental health of the patients.Mild scoliosis is often well controlled by bracing,and moderate to severe scoliosis deformity often requires scoliosis corrective surgery.In adolescent idiopathic scoliosis correction,pedi⁃cle screws offer better stability and firmness,stronger orthopedic force,and lower incidence of related complications caused by in⁃struments than traditional hook and conical internal fixation instruments.At the same time,scoliosis patients have uneven develop⁃ment of the left and right sides of the vertebral body,narrow diameter of concave pedicle and varying degrees of rotation of parietal vertebra,resulting in changes in the position of important anatomical structures such as spinal cord and thoracic aorta in the spinal canal.It makes it difficult to place pedicle screws,resulting in a high misplacement rate.How to improve the safety of screw place⁃ment,reduce the misplacement rate and the risk of spinal cord,nerve root,blood vessels,viscera and so on,has always been the focus of spinal surgeons.This paper summarizes the related literature on the effects of new techniques such as pedicle anatomy,complications of nail placement and computer navigation,and 3D guided template on the accuracy of screw placement in adoles⁃cent idiopathic scoliosis patients,and the safety of nail placement.In order to provide reference for clinical practice.
作者
杨雪健
陈焕雄
李国军
彭秋宇
黄涛
孟志斌
YANG Xue-jian;CHEN Huan-xiong;LI Guo-jun;PENG Qiu-yu;HUANG Tao;MENG Zhi-bin(Department of Spinal Surgery,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)
出处
《海南医学院学报》
CAS
2023年第11期860-865,871,共7页
Journal of Hainan Medical University
基金
海南省自然科学基金(819QN365)
国家自然科学基金(81902270)。
