Yalniz Erol, Ciftdemir Mert, Eşkin Deniz, Dülger Hakan
Department of Orthopedics and Traumatology, Medicine Faculty of Trakya University, Edirne, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):522-7. doi: 10.3944/AOTT.2009.522.
Thoracic pedicle screw fixation has many advantages over other methods of spinal fixation in treating various conditions. We evaluated the safety and efficacy of pedicle screw fixation in the thoracic spine.
We retrospectively reviewed 144 patients (65 males, 79 females; mean age 38 years; range 9 to 82 years) who underwent posterior thoracic pedicle screw instrumentation. A total of 827 thoracic pedicle screws were inserted to the thoracic spine (T1-12) by the same senior spine surgeon using the free-hand technique. Indications for thoracic spine surgery were deformities (n=47, 32.6%), metastatic or primary tumors (n=15, 10.4%), spinal infections (n=7, 4.9%), degenerative diseases (n=13, 9%), and spinal trauma (n=62, 43.1%). Screw containment was assessed by three independent reviewers on postoperative plain radiographs. In addition, thin-slice computed tomography scans were obtained in 21 suspected cases (29 screws).
Screw containment was found in 94.3% (780 screws). Incorrect screw placement was found in 47 screws (5.7%), including 31 screws (3.8%) demonstrated by plain radiographs, and 16 screws (1.9%) demonstrated by thin-slice computed tomography scans. More than half of the faulty screws (n=24, 51.1%) were detected in scoliosis patients, especially on the concave side of the curvature (83.3%). The most frequent site of faulty screw placement was the T8 level (21.3%). No symptoms or complications occurred related to faulty screw placement.
The high accuracy of thoracic pedicle screw placement (94.3%) using the free-hand technique suggests that pedicle screw fixation of the thoracic spine is safe, reliable, and useful in the treatment of all types of spinal diseases.
在治疗各种病症时，胸椎椎弓根螺钉固定术相较于其他脊柱固定方法具有诸多优势。我们评估了胸椎椎弓根螺钉固定术的安全性和有效性。
我们回顾性分析了144例接受后路胸椎椎弓根螺钉内固定术的患者（65例男性，79例女性；平均年龄38岁；年龄范围9至82岁）。同一位资深脊柱外科医生采用徒手技术在胸椎（T1 - 12）共置入827枚胸椎椎弓根螺钉。胸椎手术的适应证包括畸形（n = 47，32.6%）、转移性或原发性肿瘤（n = 15，10.4%）、脊柱感染（n = 7，4.9%）、退行性疾病（n = 13，9%）以及脊柱创伤（n = 62，43.1%）。术后通过三位独立阅片者对X线平片进行螺钉置入情况评估。此外，对21例疑似病例（29枚螺钉）进行了薄层计算机断层扫描。
94.3%（780枚螺钉）的螺钉置入位置良好。发现47枚螺钉（5.7%）置入位置不正确，其中X线平片显示31枚螺钉（3.8%）位置不正确，薄层计算机断层扫描显示16枚螺钉（1.9%）位置不正确。超过半数的置入错误螺钉（n = 24，51.1%）在脊柱侧弯患者中被检测到，尤其是在侧弯凹侧（83.3%）。螺钉置入错误最常见的部位是T8节段（21.3%）。未出现与螺钉置入错误相关的症状或并发症。
采用徒手技术进行胸椎椎弓根螺钉置入的准确率较高（94.3%），这表明胸椎椎弓根螺钉固定术在治疗各类脊柱疾病时安全、可靠且有效。
