经骶2髂骨螺钉内固定在腰骶段结核稳定性重建中的应用

发布时间：2018-02-05 23:13

本文关键词： 脊柱结核腰骶段骶髂骨螺钉手术治疗内固定　出处：《中国脊柱脊髓杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的 :评价徒手置入骶2髂骨(S2AI)螺钉的安全性,评估其在腰骶段结核稳定性重建中的应用价值。方法:2014年10月~2016年10月采用病灶清除、腰椎椎弓根-S2AI螺钉内固定、椎间植骨融合术治疗腰骶段结核患者16例,女9例,男7例,年龄38~73岁(63.5±14.3岁),其中11例大于60岁。10例患者术前骨密度检查T值-3.5。术前、术后均规范采用抗结核药物治疗方案治疗,术后采用X线片和CT评价S2AI螺钉的位置,观察螺钉的相关并发症以及结核愈合情况。结果:10例采用单纯后路内固定联合病灶清除术,6例采用一期后-前路联合的手术方式。徒手置入30枚S2AI螺钉,冠状面螺钉的外展角(α)为50°~80°(65°±14°),矢状面螺钉与S1上终板的夹角(β)为-15°~16°(0°±12°),横断面上螺钉与中垂线的夹角(θ)为45°~57°(50°±9°)。术后CT检查发现1枚(3.3%)螺钉穿破髂骨内皮质,2枚(6.7%)螺钉穿破髂骨外皮质,穿破均小于5mm,没有神经、血管损伤的情况发生。平均随访时间12个月,1例严重骨质疏松患者的2枚(6.7%)S2AI螺钉周围出现明显透光带(screw halo)。所有患者结核症状得到控制,术后6个月时血沉、C反应蛋白均降至正常,末次随访时患者均恢复正常生活;无内固定断裂的情况发生,植骨均获得融合。腰背部疼痛VAS评分由术前平均7.7±2.1分降至末次随访时的3.2±0.7分(P=0.03)。结论:徒手置入S2AI螺钉是可行且相对安全的,可用于腰骶段结核患者的稳定性重建,为结核病灶治愈提供条件。
[Abstract]:Objective: to evaluate the safety of sacral 2 iliac bone S2AII screws implanted with bare hand. Methods: from October 2014 to October 2016, focal debridement and internal fixation of lumbar pedicle -S2AI screws were performed. Intervertebral fusion was performed in 16 patients with lumbosacral tuberculosis, including 9 females and 7 males, aged from 38 to 73 years (63.5 卤14.3 years). Among them, 11 cases were over 60 years old. 10 cases had preoperative bone mineral density examination T value -3.5. Before and after operation, all patients were treated with antituberculous drugs. X ray film and CT were used to evaluate the location of S2AI screw, to observe the complications of S2AI screw and the healing of tuberculosis. Results 10 cases were treated with simple posterior internal fixation combined with debridement. In 6 cases, 30 S2AI screws were placed with bare hand. The abduction angle (伪) of the coronal screw was 50 掳, 80 掳, 65 掳卤14 掳. The angle between sagittal screw and S1 upper end plate (尾) was -15 掳and 16 掳/ 0 掳卤12 掳). The angle (胃) between the screw on the cross section and the midline was 45 掳, 57 掳and 50 掳卤9 掳. After the operation, one screw was found to break through the iliac cortex by CT examination. The two screws perforated the lateral iliac cortex less than 5 mm without nerve and vascular injury. The average follow-up time was 12 months. In one patient with severe osteoporosis, 2 cases with S2AI screw showed obvious light transmission zone around the screw. The tuberculosis symptoms of all patients were controlled, and the erythrocyte sedimentation rate (ESR) was observed 6 months after operation. C-reactive protein decreased to normal, and all patients recovered to normal life at the last follow-up. No internal fixation fracture occurred. The VAS score of lumbar back pain decreased from 7.7 卤2.1 before operation to 3.2 卤0.7 at the last follow-up. Conclusion: it is feasible and relatively safe to place S2AI screw with bare hand. It can be used to reconstruct the stability of lumbosacral tuberculosis patients and provide conditions for the cure of tuberculosis foci.
【作者单位】：中南大学湘雅二医院脊柱外科;
【基金】：湖南省自然科学基金资助项目(编号:09JJ6033)
【分类号】：R687.3

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