РЕТРОСПЕКТИВНЫЙ АНАЛИЗ МАЛЬПОЗИЦИИ ВИНТОВ ПОСЛЕ ИНСТРУМЕНТАЛЬНОЙ КОРРЕКЦИИ ДЕФОРМАЦИЙ ГРУДНОГО И ПОЯСНИЧНОГО ОТДЕЛОВ ПОЗВОНОЧНИКА

Цель исследования. Анализ количества мальпозиций винтов после инструментальной коррекции деформаций грудного и поясничного отделов позвоночника.
Материал и методы. Ретроспективный анализ данных 73 пациентов 3–58 лет с деформациями грудного и поясничного отделов позвоночника. Величина деформации по Cobb составляла 20–134° (средняя величина 61° ± 4°). В процессе коррекции деформации позвоночника установлено 1065 транспедикулярных винтов методом freehand. В послеоперационном периоде
выполняли КТ-контроль положения винтов с целью выявления мальпозиций. Оценку мальпозиций осуществляли по следующей шкале: A – нет мальпозиции, B – мальпозиция до 2 мм, C – 2–4 мм, D – более 4 мм.
Результаты. Имплантирование 628 (59,0 %) транспедикулярных винтов выполнено корректно, у 437 (41 %) – выявлено смещение траектории. У 263 (24,0 %) винтов величина мальпозиции не превышала 2 мм, у 112 (10,5 %) – достигала 4 мм и определялась как пороговая величина зоны безопасности, у 62 (5,8 %) – превышала 4 мм и расценивалась как потенциально опасная
с точки зрения первичного или отсроченного повреждения невральных структур и сосудов.
Заключение. Транспедикулярная фиксация является методом выбора при оперативной коррекции деформаций. Ее применение сопряжено с риском возникновения нейрососудистых осложнений. Наиболее доступная и распространенная методика введения винтов freehand является достаточно безопасной, однако требует от хирурга соответствующего мастерства.

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