Wang Wei-jun, Qiu Yong, Zhu Ze-zhang, Wang Bin, Zhu Feng, Yu Yang, Qian Bang-ping, Ma Wei-wei
Department of Orthopaedic, Drum Tower Hospital, Nanjing University Medical School, Nanjing 210089, China.
Zhonghua Wai Ke Za Zhi. 2007 Jun 15;45(12):829-32.
To compare the precision of the vertebral screw insertion in treating idiopathic thoracic scoliosis by thoracoscopy with that by mini anterior thoracotomy.
Ten patients with an average Cobb angle of 52.9 degrees were operated thoracoscopically (group A), and twenty-one patients with an average Cobb angle of 45.4 degrees were operated by mini anterior thoracotomy (group B). In order to determine the accuracy of screw placement, several parameters were measured postoperatively on each instrumented level of CT scan, including the entry point and entry direction of screw, the relationships between the screw tip and aorta as well as spinal canal. The safety of screw placement was determined at the position of screw to the vertebral canal and the aorta, and the results of CT analysis were designated as; D, the screw tip was distant from the aorta (> or = 1 mm); A, the screw tip was adjacent to the aorta (< 1 mm); C, the screw tip was felt to be against the aorta and creating contour deformity. The screw which had a bi-cortical purchase but was distant from the aorta and vertebral canal was defined as a satisfied screw.
73 screws were inserted into patients of Group A, and 162 into patients in Group B. Parameters measured on CT image and X-ray showed no difference between these two groups (P > 0.05). There is no difference (P > 0.05) between A and B group of percentages in D (89.0% vs. 80.2%), in bi-cortical purchase (89.0% vs. 87.0%), and in satisfaction of screw placement (74.0% vs. 66.0%).
Thoracoscopic and mini-open thoracotomic anterior correction are safe and effective to correct idiopathic right thoracic scoliosis with satisfied correction. Vertebral screws placed by both techniques have the same satisfied accuracy, safety, bi-cortical purchase and the satisfaction rate either in total screws or in the corresponding area.
比较胸腔镜与微创前胸壁切开术治疗特发性胸椎侧弯时椎弓根螺钉置入的精确性。
10例平均Cobb角为52.9度的患者接受胸腔镜手术（A组），21例平均Cobb角为45.4度的患者接受微创前胸壁切开术（B组）。为确定螺钉置入的准确性，术后在CT扫描的每个固定节段测量多个参数，包括螺钉的进针点和进针方向、螺钉尖端与主动脉及椎管的关系。根据螺钉与椎管和主动脉的位置确定螺钉置入的安全性，CT分析结果分为：D，螺钉尖端距主动脉较远（≥1mm）；A，螺钉尖端紧邻主动脉（<1mm）；C，螺钉尖端抵靠主动脉并造成轮廓变形。双皮质固定但距主动脉和椎管较远的螺钉定义为满意螺钉。
A组患者共置入73枚螺钉，B组患者共置入162枚螺钉。CT图像和X线测量的参数在两组之间无差异（P>0.05）。A组和B组在D（89.0%对80.2%）、双皮质固定（89.0%对87.0%）以及螺钉置入满意度（74.0%对66.0%）方面的百分比无差异（P>0.05）。
胸腔镜和微创前胸壁切开前路矫正术治疗特发性右胸椎侧弯安全有效，矫正效果满意。两种技术置入的椎弓根螺钉在准确性、安全性、双皮质固定以及总体螺钉或相应区域的满意度方面均相同。
