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目的：探究马方综合征合并脊柱侧凸患者在椎弓根条件较差时采用经肋椎关节置钉技术置入椎弓根螺钉的力学性能。方法：纳入2019年1月至2021年12月北京协和医院收治的12例马方综合征合并脊柱侧凸患者，获取患者的脊柱CT影像资料，使用SurgiPlan AI V1.0软件建立患者脊柱的3D模型，采用传统沿椎弓根置钉技术和经肋椎关节置钉技术模拟置入椎弓根螺钉，记录椎弓根螺钉的直径和长度、置钉节段、置钉凹凸侧、椎弓根螺钉拔出力，并进行比较。结果：模拟传统沿椎弓根置钉技术和经肋椎关节置钉技术分别置入288枚椎弓根螺钉，共576枚。经肋椎关节置钉组的椎弓根螺钉直径和长度均大于传统置钉组（P均<0.05）。随着T1～12节段向下，两组椎弓根螺钉拔出力逐渐变大；经肋椎关节置钉组的椎弓根螺钉拔出力在T1～12节段均大于传统置钉组，除T3和T4节段外，其余各节段两组比较差异均有统计学意义（P均<0.05）。经肋椎关节置钉组的椎弓根螺钉拔出力在脊柱凹侧与凸侧均大于传统置钉组（P均<0.05），两组中脊柱凹侧的椎弓根螺钉拔出力均大于脊柱凸侧（P均<0.05）。结论：对于马方综合征合并脊柱侧凸这类椎弓根条件较差的患者，经肋椎关节置钉技术较传统沿椎弓根置钉技术可以选取更大尺寸的椎弓根螺钉，从而获得更好的力学稳定性。
Abstract：Objective: To investigate the mechanical performance of costovertebral joint pedicle screw placement technique in scoliosis patients with Marfan syndrome when traditional pedicle screw placement is challenging. Methods: A total of 12 patients with scoliosis and Marfan syndrome treated at Peking Union Medical College Hospital from January 2019 to December 2021 were included.Spinal CT imaging data of the patients were obtained, and 3D models of the patients' spines were constructed using SurgiPlan AI V1.0software. Both traditional pedicle screw placement and costovertebral joint screw placement techniques were simulated. The diameter and length of the pedicle screws, the levels of screw placement, the concave/convex sides of screw placement, and the pullout strength of the pedicle screws were recorded. Results: A total of 576 pedicle screws were simulated, with 288 screws placed using the traditional pedicle screw placement technique and 288 screws placed using the costovertebral joint screw placement technique. The diameter and length of the pedicle screws in the costovertebral joint screw placement group were significantly larger than those in the traditional pedicle screw placement group(both P<0.05). From T1 to T12, the pullout strength of the pedicle screws gradually increased in both groups. The pullout strength of the pedicle screws in the costovertebral joint screw placement group was higher than that in the traditional screw placement group at all levels from T1 to T12, with statistical significance observed for all segments except T3 and T4(all P<0.05). The pullout strength of the pedicle screws in the costovertebral joint screw placement group was significantly higher than that in the traditional screw placement group on both the concave and convex sides of the spine(all P<0.05). The pullout strength of the pedicle screws on the concave side was significantly higher than that on the convex side in both groups(all P<0.05). Conclusions: For patients with challenging pedicle conditions, such as those with Marfan syndrome complicated by scoliosis, the costovertebral joint screw placement technique allows for the use of larger pedicle screws compared to the traditional pedicle screw placement technique,thereby achieving superior mechanical stability.
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]余伟杰,王升儒,杜悠等.马方综合征合并脊柱侧凸经肋椎关节置钉的力学分析[J].中华骨与关节外科杂志,2025,18(03):231-236.
基金信息:
国家重点研发计划项目（2023YFC2507700）