Ruf Michael, Harms Jürgen
Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):E460-6. doi: 10.1097/00007632-200211010-00019.
A retrospective study of 19 consecutive cases (1991-2001) where 91 thoracic and lumbar pedicle screws were used in the treatment of various pediatric spinal disorders in 1- and 2-year-old children.
To determine the effectiveness and safety of pedicle screw fixation in very young children and to evaluate the effect of pedicle screw insertion on further growth of the vertebra.
Although many studies exist about the use of pedicle screws and its advantages in spinal fixation in adults and older children, no study has been published about the use of pedicle screws in 1- and 2-year-old children.
A retrospective review of 19 consecutive operations in 16 patients with insertion of 91 pedicle screws for various spinal disorders in 1- and 2-year-old children was performed. The technique of screw insertion was described. Complications were divided into those directly related to screw placement and general complications and short- and long-term complications. In three cases with more than 6 years follow-up, the effect of pedicle screw insertion on further growth was evaluated by radiographic measurements.
Short-term complications occurred in two patients (one pedicle fracture, one infection) and long-term complications in three patients (one screw breakage, two failures of screw connection). Three of 91 screws were misplaced without any neurologic symptoms. Measurements of the vertebral growth in long-term follow-up did not show any adverse effect related to pedicle screw insertion.
The results suggest that pedicle screw fixation can be performed safely in 1- and 2-year-old children without negative effects on vertebral growth. In various pediatric spinal disorders, transpedicular screw fixation is the only procedure that provides a secure anchorage in short-segment instrumentation.
对1991年至2001年间连续19例病例进行回顾性研究，其中91枚胸腰椎椎弓根螺钉用于治疗1岁和2岁儿童的各种小儿脊柱疾病。
确定椎弓根螺钉固定在幼儿中的有效性和安全性，并评估椎弓根螺钉植入对椎体进一步生长的影响。
尽管已有许多关于椎弓根螺钉在成人和大龄儿童脊柱固定中的应用及其优势的研究，但尚未有关于在1岁和2岁儿童中使用椎弓根螺钉的研究发表。
对16例患者连续进行的19次手术进行回顾性分析，这些手术为1岁和2岁儿童因各种脊柱疾病植入了91枚椎弓根螺钉。描述了螺钉植入技术。并发症分为与螺钉置入直接相关的并发症、一般并发症以及短期和长期并发症。对3例随访超过6年的病例，通过影像学测量评估椎弓根螺钉植入对进一步生长的影响。
2例患者出现短期并发症（1例椎弓根骨折，1例感染），3例患者出现长期并发症（1例螺钉断裂，2例螺钉连接失败）。91枚螺钉中有3枚位置不当，但无任何神经症状。长期随访中对椎体生长的测量未显示与椎弓根螺钉植入相关的任何不良影响。
结果表明，在1岁和2岁儿童中进行椎弓根螺钉固定是安全的，对椎体生长无负面影响。在各种小儿脊柱疾病中，经椎弓根螺钉固定是在短节段器械固定中提供可靠锚固的唯一方法。
