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首页> 外文期刊>Spine >Complications of thoracic pedicle screws in scoliosis treatment.
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Complications of thoracic pedicle screws in scoliosis treatment.

机译：胸椎弓根螺钉在脊柱侧凸治疗中的并发症。

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STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). SUMMARY OF BACKGROUND DATA: The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. METHODS: A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4 degrees (range, 60 degrees -105 degrees ). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable. RESULTS: An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. CONCLUSIONS: The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.
机译：研究设计：一项回顾性研究。目的：分析我科过去三年（1999-2001年）在脊柱侧弯治疗中使用胸椎椎弓根螺钉的并发症。背景技术摘要：由于担心并发症，椎弓根螺钉的使用对于胸椎侧弯仍然存在争议。方法：回顾性分析115例行1035椎弓根螺钉行后路融合术的患者。所有患者均表现为主要的胸椎侧弯，平均Cobb角为75.4度（范围60度-105度）。对于胸椎螺钉置入术，使用了微型椎间盘切开术，将刮铲插入椎管内以触诊椎弓根的边界。 25例患者（21.7％）接受了术后CT扫描，以研究总共311颗螺钉的位置，此时螺钉位置存在问题。结果：一名独立的脊柱外科医生对患者的病历和X光片进行了回顾性检查，平均随访4年。在总共13例患者（11.3％）中，有18个螺钉放错了位置（1.7％）。仅有1例（胸腔积液和发烧）有症状的螺钉异常，其他12例（10.4％）无症状。其他并发症包括术中椎弓根骨折15例（13％），硬脑膜撕裂（无神经系统并发症）14例（12.1％）和浅表伤口感染2例（1.7％）。由于胸腔积液（1例），无症状的外侧螺钉松动（无症状），无症状的晚期外侧松动（5例），另外5例患者（4.3％）进行了螺钉切除术，并且尽管缺乏任何症状（3）。 2例（1.7％）因伤口感染被撤退，未移除器械。随访中没有损失矫正。结论：脊柱侧凸患者的胸椎椎弓根螺钉置入术需格外小心。迷你剖腹术在增加手术安全性和并发症发生率方面是有益的。

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