幼儿胸腰椎置人椎弓根螺钉可行性临床研究

摘要

目的 探讨在1～3岁的幼儿下胸椎和腰椎置入椎弓根螺钉的可行性和安全性.方法 2002年1月至2007年1月,对10例1～3岁下胸椎和腰椎疾患患儿应用成人颈椎侧块螺钉进行固定矫形,男7例,女3例;年龄1～3岁,其中1～2岁4例,2～3岁6例.先天性半椎体畸形合并脊柱侧凸7例,均为完全分节的单个游离半椎体,不合并对侧分节不全;椎体肿瘤2例,为合并椎管内占位的嗜酸性肉芽肿;脊柱结核1例,为中心型椎体结核并后凸畸形.病变椎体:L3(1例),L2(3例),L1(4例),T12(2例).病变节段为1～2个.经测量T11～L5椎弓根的上下径为5.2～9.0 mm,平均6.5 mm;左右径为3.5～8.0 mm,平均4.6mm.结果 10例患儿共置入40枚螺钉,未发生大血管和神经损伤.3例患儿CT扫描发现各有1枚螺钉置人偏外,并穿破椎弓根和椎体的外缘皮质,其中1例患儿出现1枚螺钉过长超出椎体前缘,但均未损伤血管及内脏.随访时间2～3年,平均2.6年.1例L3椎体嗜酸性肉芽肿患儿,术后6个月时X线片显示L2～L4局部有轻度后凸畸形,但3年后后凸畸形基本自行矫正.10例内固定物在手术后2～3年取出,在随访期间未见内固定物松动及断裂.结论 在1～3岁幼儿的下胸椎和腰椎置入椎弓根螺钉在技术上可行、安全.%Objective To investigate the feasibility arid safety of utilizing pedicle screw in lower thoracic or lumbar spine in infant patients aged 1 to 3 years. Methods A retrospective review was made about 10 infants aged 1-3 years who underwent pedicle-screw fixation in lower thoracic or lumbar spine during January 2002 to January 2007. Seven patients were male,3 female. Four of the ten patients were 1-2 yeats old. Seven patients suffered from congenital full-segmented hemivertebra complicated with scoliosis,2 suffered from spinal tumor of eosinophilic granuloma with spinal cord compression,1 suffered from spinal tuberculosis accompanied with kyphotic deformity. The effectiveness and complication of this procedure were analyzed. The lesion involved in L3 for 1 case,L2 for 3 cases,L1 for 4 cases,T12 for 2 cases. Results All the 10 patients were discharged evenflessly. No neurovascular injury was found in 10 patients who were implanted 40 pedicle-screws. The follow-up duration was 2 to 3 years,with the mean of 2.6 years. One patient was detected kyphosis in operative site six months after operation,but three years later the kyphotic deformity was corrected spontaneously. The follow-up CT scans demonstrated one screw was placed over laterally and penetrated the anterior cortex of vertebral body in three patients,but no vascular or visceral injury occurred. The internal fixators were removed 2-3 years after surgery in ten patients. No internal fixators breakage was found in all patients during follow-up duration.Conclusion Pedicle-screw technique in lower thoracic or lumbar spine of infant is feasible and safe.