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目的:探讨10岁以下小儿胸腰椎椎弓根钉固定的可行性及安全性。方法:对19例平均年龄6.5岁的胸腰椎疾患患儿,2例骨折脱位患者采用后路短节段椎弓根钉复位固定;3例肿瘤患者采用后路切除肿瘤、短节段椎弓根钉固定;10例先天性半椎体患者采用后路半椎体切除、椎弓根钉矫形固定或前后联合手术;4例脊柱侧凸患者采用后路椎弓根钉矫形固定。椎弓根钉置入点及方向与成人相似,螺钉直径为拟固定椎弓根横径的80%￣90%,长度达椎体的70%￣80%。手术后观察各螺钉位置,随访观察内固定稳定性及神经功能情况。结果:共置入83枚椎弓根钉,术中3个椎弓根破裂造成矫形时螺钉松动,均上移或下移一个节段完成固定;术后检查3枚螺钉位置不良,因未造成神经损害,对固定的稳定性无影响,未做处理。无脊髓神经和血管损伤及感染。18例获得平均24个月随访,1例术后1年螺钉断裂进行了翻修,其余患者无内固定松动。3例术前有神经功能障碍的患者均有明显恢复。结论:在详细的术前计划,选择恰当直径的椎弓根钉、精湛的外科技术下行小儿胸腰椎椎弓根螺钉固定是安全可行的。
Objective: To investigate the feasibility and safety of pediatric thoracolumbar pedicle screw fixation under 10 years old. Methods: Thirteen patients with thoracolumbar spine disease of average age 6.5 years old and two patients with fracture and dislocation were treated with short posterior pedicle screw fixation and reduction. Three patients underwent posterior resection of tumor and short segment pedicle 10 cases of congenital hemivertebrae were treated by posterior hemivertebra resection, pedicle screw fixation and anterior or posterior surgery. Four cases of scoliosis were fixed by posterior pedicle screw fixation. Pedicle screw insertion point and the direction and adults similar to the diameter of the screw is intended to be fixed pedicle diameter 80% ~ 90% of the length of the vertebral body 70% ~ 80%. After surgery, the position of each screw was observed. The stability of internal fixation and neurological function were observed. Results: A total of 83 pedicle screws were implanted. During operation, 3 pedicle screws ruptured and caused loosening of the screws. All of them were moved up or down by one segment to complete the fixation. Postoperatively, 3 screws were not properly positioned, Nerve damage, no effect on the stability of the fixed, no treatment. No spinal cord nerve and vascular injury and infection. Eighteen patients were followed up for an average of 24 months. One patient had a revision of the screw rupture one year after operation. The rest patients had no loose internal fixation. Three patients with preoperative neurological dysfunction were significantly recovered. CONCLUSIONS: In a detailed preoperative planning, the pedicle screw fixation of pediatric thoracolumbar pedicle screws is safe and feasible with the selection of appropriate diameter pedicle screws and superb surgical techniques.