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目的观察在术中CT导航引导下行小儿脊柱后路半椎体切除、椎弓根螺钉内固定的置钉准确率及近期疗效。方法 10例先天性半椎体畸形的患儿,手术时年龄为3～6岁,平均4.5岁。所有患儿均为单发完全分节半脊椎,其中半脊椎1例位于T10,2例位于T11,3例位于T12、2例位于L2,1例位于L3,1例位于L4。术中在CT导航引导下进行置钉和半椎体切除。结果本组病例共置椎弓根螺钉48枚,经术中CT扫描证实位置良好,无穿透椎弓根内侧壁进入椎管者,大部分螺钉刚好穿出椎体前缘皮质骨,置钉准确率达100%。术前半脊椎上下相邻节段侧凸Cobb角为20.0°～60.0°,平均40.5°,术后矫正至1.0°～14.0°,平均矫正至8.3°,平均矫正率为78.5%。在6例胸椎半脊椎病例中,术前半脊椎上下相邻节段后凸Cobb角为23.0°～36.0°,平均29.3°,术后Cobb角矫正至0°～13.0°,平均矫正至8.3°,平均矫正率为69.5%;在4例腰椎半脊椎病例中,半脊椎上下相邻节段后凸Cobb角为0°～2.0°,平均1.5°,术后腰椎前凸恢复至8.0°～18.0°,平均恢复腰椎前凸13.0°。本组病例平均随访5个月,未发生螺钉松脱、折断等并发症,远近端代偿弯基本恢复正常。结论利用术中CT导航系统有利于在小儿患者中准确地置入椎弓根螺钉,能够有效增加矫形力和防止内固定的失败,使得切除小儿半脊椎更加简便和安全。
Objective To observe the accuracy and short-term curative effect of pedicle screw fixation and pedicle screw fixation in pediatric posterior spinal posterior hemivertebra resection guided by CT navigation during operation. Methods Ten patients with congenital hemivertebra deformity were aged 3 to 6 years with an average of 4.5 years. All children had a single, fully segmented, semicircular vertebra, with one of the hemispheres located at T10, two at T11, three at T12, two at L2, one at L3 and one at L4. Under the guidance of CT navigation during surgery and hemisection. Results In this group of patients, 48 pedicle screws were co-located. CT scan showed good location and no penetrating pedicle medial wall into the vertebral canal. Most of the screws just pierced the anterior vertebral cortical bone, Accuracy of 100%. The Cobb angle was 20.0 ° ~ 60.0 °, with an average of 40.5 ° in the adjacent upper and lower semicircular segments. The average correction rate was 1.0 ° ~ 14.0 ° after correction. The average correction rate was 78.5%. In 6 cases of thoracic semicircular spine, Cobb angle was 23.0 ° ~ 36.0 ° (average 29.3 °), Cobb angle was corrected to 0 ° ~ 13.0 °, with a mean correction to 8.3 °, The average correction rate was 69.5%. In 4 cases of lumbar and semi-vertebra, the Cobb angle of upper and lower adjacent segments was 0 ° ~ 2.0 ° with an average of 1.5 °. The lumbar lordosis recovered to 8.0 ° ~ 18.0 ° , The average lumbar lordosis restored 13.0 °. The average follow-up of this group of patients for 5 months, no screw loosening, fracture and other complications, far and near compensatory bend back to normal. Conclusion The use of intraoperative CT navigation system is conducive to the pediatric patients with accurate placement of pedicle screws, can effectively increase the orthopedic force and prevent the failure of internal fixation, making the removal of pediatric semicircular spine more simple and safe.