Wang Bing, Lü Guo-hua, Kang Yi-jun, Li Jing, Chen Fei, Deng You-wen, Liu Wei-dong
Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhonghua Wai Ke Za Zhi. 2009 May 15;47(10):770-3.
To analyze the accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment.
Twenty-three cases of severe kyphoscoliosis between June 1996 and December 2007 underwent pedicle screw placement of thoracic vertebrae by interlaminar fenestration technique. Postoperative CT scan was performed in all cases; there were 9 males and 14 females with the averaging age 17.8 years old. The preoperative Cobb angle of the main thoracic curve was 97.3 degrees in average. The average kyphotic angle in main curve was 67.4 degrees . Patients who underwent screw placement by closing technique and postoperative CT scan in the same stage with severe kyphoscoliosis were selected as control group (B): there were 22 patients with the averaging age 17.2 years old. The preoperative Cobb angle of the main thoracic curve was 96.6 degrees in average. The average kyphotic angle in main curve was 62.1 degrees . The screw-related complications were analyzed and online measure and analyze the degree of screw penetration according to CT by statistics.
There were 209 thoracic pedicle screws being inserted in group A, no spinal cord and large blood vessel injury occurred, 5 patients occurred intraoperative pedicle fracture, dura lesion had 4 patients. Screws misplacement ratio was 8.6%, there were 11 screws located in the thoracic pedicle laterally, 6 screws located in medially, 1 screw presented a moderate anterior cortical perforation. The number of screws misplacement in upper and mild thoracic vertebrae were 15, occupied 83.3%; the number of screws misplacement in lower thoracic vertebrae were 3, occupied 16.7%. There was statistics difference (P < 0.05). Of the total 116 thoracic pedicle screws inserted on the convex side, the ratio of screw misplacement was 5.2%; 93 screws on the concave side, the ratio of screw misplacement was 12.9%, there was statistics difference (P < 0.05). There were 201 thoracic pedicle screws being inserted in group B, no spinal cord and large blood vessel injury occurred, 16 patients occurred intraoperative pedicle fracture, dura lesion had 7 patients. The ratio of screw misplacement was 22.4%, there were 24 screws located in the thoracic pedicle laterally, 11 screws located in medially, 10 screw presented a moderate anterior cortical perforation. The ratio of screw misplacement in Group B was higher than Group A (P < 0.05). All cases received 3.2 years and 3.4 years follow-up. There was no obvious loss of correction in coronal and sagittal plane at the latest follow-up.
It is technically demanding for placement of thoracic screw in the severe kyphoscoliosis treatment. The interlaminar fenestration technique can increase the accuracy and safety of thoracic pedicle screw placement.
分析严重脊柱侧凸畸形治疗中经椎板间隙开窗技术置入胸椎椎弓根螺钉的准确性及安全性。
1996年6月至2007年12月收治的23例严重脊柱侧凸畸形患者采用经椎板间隙开窗技术置入胸椎椎弓根螺钉。所有患者术后均行CT扫描；男9例，女14例，平均年龄17.8岁。胸椎主弯术前Cobb角平均为97.3°。主弯平均后凸角为67.4°。选择同期采用闭合技术置入螺钉并行术后CT扫描的严重脊柱侧凸畸形患者作为对照组（B组）：共22例，平均年龄17.2岁。胸椎主弯术前Cobb角平均为96.6°。主弯平均后凸角为62.1°。分析螺钉相关并发症，并根据CT对螺钉置入深度进行在线测量及统计学分析。
A组共置入胸椎椎弓根螺钉209枚，未发生脊髓及大血管损伤，5例患者术中发生椎弓根骨折，4例患者发生硬脊膜损伤。螺钉误置率为8.6%，其中11枚螺钉位于椎弓根外侧，6枚螺钉位于内侧，1枚螺钉出现中度前方皮质穿孔。上胸椎及轻度胸椎螺钉误置15枚，占83.3%；下胸椎螺钉误置3枚，占16.7%。差异有统计学意义（P<0.05）。凸侧共置入116枚胸椎椎弓根螺钉，螺钉误置率为5.2%；凹侧93枚螺钉，螺钉误置率为12.9%，差异有统计学意义（P<0.05）。B组共置入胸椎椎弓根螺钉201枚，未发生脊髓及大血管损伤，16例患者术中发生椎弓根骨折，7例患者发生硬脊膜损伤。螺钉误置率为22.4%，其中24枚螺钉位于椎弓根外侧，11枚螺钉位于内侧，10枚螺钉出现中度前方皮质穿孔。B组螺钉误置率高于A组（P<0.05）。所有患者均获得3.2年及3.4年随访。末次随访时冠状面及矢状面未见明显矫正丢失。
严重脊柱侧凸畸形治疗中胸椎螺钉置入技术要求高。经椎板间隙开窗技术可提高胸椎椎弓根螺钉置入的准确性及安全性。
