Lehman Ronald A, Lenke Lawrence G, Keeler Kathryn A, Kim Yongjung J, Cheh Gene
Walter Reed Army Medical Center, Washington, DC, USA.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2679-84. doi: 10.1097/BRS.0b013e31815a7f13.
A retrospective review.
To evaluate the incremental accuracy of pedicle screws used in spinal deformity via a free-hand technique at a single institution over an 8-year period.
The in vivo accuracy of free-hand pedicle screws placed throughout the deformed spine as evaluated by computed tomography (CT) scanning is unknown over a long time period.
A total of 1023 pedicle screws inserted from T1 to L4 in 60 patients (928 screws in 54 scoliosis patients and 95 screws in 6 kyphosis patients) over an 8-year period were investigated via postoperative CT scans. Patients were divided into 3 groups (group I = 1998-1999, group II = 2001-2002, and group III = 2005). All pedicle screws were inserted via the free-hand technique using anatomic landmarks, specific entry sites, neurophysiologic, and radiographic confirmation. Pedicle screw position on CT scan was graded as acceptable versus violated, defined as the screw axis being outside the pedicle wall.
One hundred seven of 1023 pedicle screws (10.5%) demonstrated significant mediolateral pedicle wall violations (19 medial vs. 88 lateral, P = 0.001). groups I and III had significantly higher lateral wall violations than group II (P < 0.05) as did the kyphotic spines (vs. scoliotic spine, P < 0.05). There were significantly more screws placed in the periapical region over time (P < 0.0001), with left-sided lateral violations (T5-T8) increasing from group II to group III, while the number of medial violations significantly decreased with time (P < 0.0001). Pedicle screws placed on the right side showed a significant decrease in accuracy from group II to group III (P = 0.03). The average transverse angle of the acceptable screws was 15.3 degrees which was significantly different from the medial (23.0 degrees , P < 0.001) and lateral (10.6 degrees , P < 0.001) violations between group I and group II. No screws demonstrated neurologic, vascular, or visceral complications.
Overall accuracy of acceptable screws using the free-hand pedicle screw placement technique in the deformed spine was 89.5%, without any neurologic, vascular, or visceral complications over an 8-year period. The rate of medial violations decreased with time, as the number of screws placed in the periapical region increased.
一项回顾性研究。
评估在一家机构中，8年间通过徒手技术置入脊柱畸形椎弓根螺钉的额外准确性。
长期以来，通过计算机断层扫描（CT）评估在整个畸形脊柱上徒手置入椎弓根螺钉的体内准确性尚不清楚。
对8年间60例患者（54例脊柱侧凸患者的928枚螺钉和6例脊柱后凸患者的95枚螺钉）从T1至L4置入的1023枚椎弓根螺钉进行术后CT扫描研究。患者分为3组（I组 = 1998 - 1999年，II组 = 2001 - 2002年，III组 = 2005年）。所有椎弓根螺钉均通过徒手技术，利用解剖标志、特定进针点、神经生理学和影像学确认置入。CT扫描上椎弓根螺钉位置分为可接受与侵犯，侵犯定义为螺钉轴线位于椎弓根壁之外。
1023枚椎弓根螺钉中有107枚（10.5%）显示有明显的内外侧椎弓根壁侵犯（内侧19枚 vs. 外侧88枚，P = 0.001）。I组和III组的外侧壁侵犯显著高于II组（P < 0.05），脊柱后凸患者也是如此（与脊柱侧凸患者相比，P < 0.05）。随着时间推移，根尖周区域置入的螺钉显著增多（P < 0.0001），左侧外侧侵犯（T5 - T8）从II组到III组增加，而内侧侵犯数量随时间显著减少（P < 0.0001）。右侧置入的椎弓根螺钉从II组到III组准确性显著降低（P = 0.03）。可接受螺钉的平均横角为15.3度，与I组和II组之间内侧侵犯（23.0度，P < 0.001）和外侧侵犯（10.6度，P < 0.001）有显著差异。未发现螺钉有神经、血管或内脏并发症。
在畸形脊柱中使用徒手椎弓根螺钉置入技术，可接受螺钉的总体准确率为89.5%，8年间无任何神经、血管或内脏并发症。随着根尖周区域置入螺钉数量增加，内侧侵犯率随时间下降。
