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1、腰椎椎弓根螺钉内固定并发症及预防首都医科大学附属北京朝阳医院骨科杜心如椎弓根螺钉植入技术问题1、过深----穿出椎体2、过浅----固定强度不够3、直径太粗大----胀破椎弓根4、角度不正确----进入椎管、椎弓根外5、进钉点不正确----偏内偏外、偏上、偏下学习目标熟悉椎弓根螺钉植入中出现的各种问题并能灵活预防措施及解决方法一、螺钉过深过长（一）病症1、易引起椎体前方结构损伤2、大血管迟发破裂大出血休克死亡locatedintheTomb,DongShenJiabang,deferthenextdayfocusedontheass
2、assination.Linping,Zhejiang,1ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame （二）预防选择合适长度的螺钉根据腰椎侧位片推算螺钉长度d约等于0.83b在腰椎CT测量（经椎弓根平面）（三）参考资料locatedintheTomb,DongShenJiabang,deferthenextdayfocusedontheassassinat
3、ion.Linping,Zhejiang,1ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame1、移行椎滑脱男38岁术前测量 2、术前CT测量椎弓根螺钉最大长度locatedintheTomb,DongShenJiabang,deferthenextdayfocusedontheassassination.Linping,Zhejiang,1ofwhichliqu
4、orwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame 3、侧位片进钉深度比率测量方法平均值87.6±4.8%。一般长度40-45mm，不超过50mm二、螺钉太短（一）缺点1、固定强度不够2、侧位片上比率<50%locatedintheTomb,DongShenJiabang,deferthenextdayfocusedontheassassination.Linping,Zhejiang,1
5、ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame（二）预防侧位片上进钉深度占椎体前后径80%选择合适长度腰椎螺钉不小于40mm（三）螺钉直径太粗及预防一般直径在4.0mm-6.0mm之间选择粗细根据椎弓根最狭窄处横径我们资料横径小于4.0mm在2.6%-30%最小值为2mmL1、L2椎弓根较细女性尤其注意术前CT上测量椎弓根横径locatedintheTomb,Don
6、gShenJiabang,deferthenextdayfocusedontheassassination.Linping,Zhejiang,1ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame（四）进钉部位及角度不准确钉点偏外，则进钉角度要大否则穿破椎弓根外侧皮质椎体外进钉点偏内，则进钉角度要小否则进入椎管损伤神经根及脊髓 进钉角度偏小，钉在外 三、腰椎椎弓根定位
7、方法（一）国内、外情况1、国内陈耀然(1982)单云官(1988)郑祖根(1988)候树勋(1994)王景臣(1998)2、国外locatedintheTomb,DongShenJiabang,deferthenextdayfocusedontheassassination.Linping,Zhejiang,1ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcameMager
8、l(1984)Roy-Camille(1986)Weintein(1988)Krag(1989)“AO”(1991)（二）参考资料（三）横突平分线作为腰椎椎弓根横向定位标志横突平分线在椎弓根中心点的下方横突变异术中显露横突较困难逐一过
