Department of Neurological Surgery, University of California, 505 Parnassus Ave., Box 0112, San Francisco, CA 94143-0112, USA.
Eur Spine J. 2010 May;19(5):821-7. doi: 10.1007/s00586-010-1293-1. Epub 2010 Feb 5.
Free-hand thoracic pedicle screw placement is becoming more prevalent within neurosurgery residency training programs. This technique implements anatomic landmarks and tactile palpation without fluoroscopy or navigation to place thoracic pedicle screws. Because this technique is performed by surgeons in training, we wished to analyze the rate at which these screws were properly placed by residents by retrospectively reviewing the accuracy of resident-placed free-hand thoracic pedicle screws using computed tomography imaging. A total of 268 resident-placed thoracic pedicle screws was analyzed using axial computed tomography by an independent attending neuroradiologist. Eighty-five percent of the screws were completely within the pedicle and that 15% of the screws violated the pedicle cortex. The majority of the breaches were lateral breaches between 2 and 4 mm (46%). There was no clinical evidence of neurovascular injury or injury to the esophagus. There were no re-operations for screw replacement. We concluded that under appropriate supervision, neurosurgery residents can safely place free-hand thoracic pedicle screws with an acceptable breach rate.
徒手胸椎椎弓根螺钉置入术在神经外科住院医师培训计划中越来越流行。该技术在不使用透视或导航的情况下，利用解剖标志和触觉触诊来放置胸椎椎弓根螺钉。由于该技术是由受训的外科医生进行的，我们希望通过回顾使用计算机断层扫描成像评估住院医师放置的徒手胸椎椎弓根螺钉的准确性，来分析这些螺钉被正确放置的比率。总共对 268 个由住院医师放置的胸椎椎弓根螺钉进行了轴向计算机断层扫描分析，由一位独立的主治神经放射科医生进行。85%的螺钉完全位于椎弓根内，15%的螺钉侵犯了椎弓根皮质。大多数的侵犯是 2 到 4 毫米之间的侧方侵犯（46%）。没有出现神经血管损伤或食管损伤的临床证据。没有因螺钉更换而再次手术。我们的结论是，在适当的监督下，神经外科住院医师可以安全地放置徒手胸椎椎弓根螺钉，其螺钉突破率可接受。
