本文選題：下腰椎 + 骶骨　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:多中心研究統(tǒng)計分析第3腰椎(L3),第4腰椎(L4),第5腰椎(L5)及第1骶椎(S1)的后路椎弓根置釘準確性,并分析造成椎弓根穿透的原因。方法:回顧性分析2014年1月至2014年12月符合納入及排除標準、接受腰骶椎后路椎弓根釘-棒系統(tǒng)固定手術(shù)的患者共401例,其中包括152節(jié)L3椎體,219節(jié)L4椎體,270節(jié)L5椎體及95節(jié)S1椎體。術(shù)后24-48小時內(nèi)對所有患者均進行腰骶椎CT平掃及重建,2名專業(yè)人員評估L3,L4,L5及S1椎弓根螺釘在椎弓根區(qū)域的位置。對于穿透椎弓根的螺釘,記錄其穿透位置與程度,詳細統(tǒng)計螺釘在腰骶椎各節(jié)段的穿透情況,分析椎弓根穿透的相關(guān)因素。對三所醫(yī)院間以及不同脊柱疾病間椎弓根螺釘穿透率差異進行統(tǒng)計分析。對所有病人均進行術(shù)后臨床癥狀的隨訪觀察,記錄所有可能因椎弓根螺釘穿透而導(dǎo)致的并發(fā)癥。結(jié)果:401例患者共置入椎弓根螺釘1467枚,其中穿透椎弓根側(cè)壁的螺釘371枚。L3 節(jié)段穿透率為 30.2%(91/301),L4節(jié)段為 28.9%(126/436),L5 節(jié)段為 24.5%(132/539),S1節(jié)段為11.5%(22/191)。椎弓根螺釘在L3,L4和L5節(jié)段穿透率的差異無統(tǒng)計學(xué)意義,但均高于S1節(jié)段,差異均有統(tǒng)計學(xué)意義。椎弓根穿透位置統(tǒng)計結(jié)果顯示,L3節(jié)段內(nèi)下緣穿透率為47.3%(43/91),L4節(jié)段為58.7%(74/126),L5 節(jié)段為 75%(99/132),S1節(jié)段為 86.4%(19/22)。與 L3,L4節(jié)段相比,L5和S1椎弓根螺釘穿透更集中于椎弓根內(nèi)下緣。穿透嚴重程度統(tǒng)計結(jié)果顯示,L3節(jié)段高危穿透率(Ⅲ級Ⅳ級)為8.8%(8/91),L4節(jié)段為6.3%(8/126),L5節(jié)段為14.4%(19/132),S1節(jié)段為36.4%(8/22);L5 S 節(jié)段達到嚴重破損的比例均明顯高于L3,L4節(jié)段。三所醫(yī)院間穿透率的差異有統(tǒng)計學(xué)意義,而各醫(yī)院椎弓根螺釘穿透節(jié)段、穿透程度以及穿透位置的特點與總體結(jié)果趨于一致。椎間盤突出癥,椎體滑移和椎管狹窄組的椎弓根穿透率均高于椎體骨折組,而不同組別間穿透程度以及穿透位置的特點與總體結(jié)果一致,且相互間無顯著差異。在椎弓根穿透的病例中9例發(fā)生腦脊液漏,3例神經(jīng)損傷表現(xiàn)。所有發(fā)生并發(fā)癥的患者均未進行翻修手術(shù),采取保守治療后臨床癥狀有效緩解。結(jié)論:L5椎弓根與L3,L4具有同樣的高穿透率。在穿透事件中,L5,S1椎弓根達到高危穿透的比例更高,且更多地集中于椎弓根內(nèi)下緣,這與椎弓根的解剖形態(tài)密切相關(guān)。此外,低級別醫(yī)院以及退變性疾病中發(fā)生椎弓根釘穿透的比例及相關(guān)并發(fā)癥更高。椎弓根穿透引起相關(guān)并發(fā)癥并不多見,但仍應(yīng)引起重視。
[Abstract]:Objective: to analyze the accuracy of posterior pedicle screw insertion in the third lumbar vertebra (L3), the 4th lumbar vertebrae (L4), the 5th lumbar vertebra (L5) and the first sacral vertebra (S1), and to analyze the causes of pedicle penetration. Methods: from January 2014 to December 2014, 401 cases of lumbar and sacral posterior pedicle screw fixation were retrospectively analyzed. These include 152 L3, 219 L4, 270 L5 and 95 S1 vertebrae. All patients underwent lumbar and sacral CT plain scan and reconstruction within 24 to 48 hours after operation. Two professionals evaluated the position of L3L4, L5 and S1 pedicle screws in the pedicle area. For the screws penetrating the pedicle, the penetrating position and degree were recorded, the penetration of screws in each segment of lumbosacral vertebrae was analyzed in detail, and the related factors of pedicle penetration were analyzed. The differences of pedicle screw penetration rate among three hospitals and different spinal diseases were analyzed statistically. All patients were followed up to record all possible complications caused by pedicle screw penetration. Results 1467 pedicle screws were inserted into the lateral wall of pedicle of 1467 cases. The penetration rate of L3 segment was 30.2% (91 / 301) and 28.9% (126 / 436) in L4 segment, 24.5% (132 / 539) in S1 segment and 11.5% (22 / 191) in S1 segment. There was no significant difference in the penetration rate of pedicle screw between L3, L4 and L5, but they were higher than those in S1, and the differences were statistically significant. The results of pedicle penetration location showed that the penetration rate of L3 segment was 47.3% (43 / 91) and that of L4 segment was 58.7% (74 / 126), and that of L5 segment was 75% (99 / 132), and that of S1 segment was 86.4% (19 / 22). The transpedicle screw penetration of L5 and S1 was more concentrated in the lower margin of the pedicle than in the L3 or L4 segment. The statistical results of penetration severity showed that the high risk penetration rate of L3 segment (grade 鈪，

本文編號：2050609