Department of Orthopedics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Eur Spine J. 2012 Jan;21(1):23-30. doi: 10.1007/s00586-011-1962-8. Epub 2011 Aug 13.
To determine the ideal entry point for individual pedicle screw in the surgical treatment of idiopathic scoliosis using computed tomographic (CT) three-dimensional (3D) reconstruction.
Twenty patients with moderate or severe idiopathic scoliosis from two groups received surgical treatment using "Free Hand technique" and "Assisted Free Hand technique". Computed tomographic scanning with 3D reconstruction of the thoracic and lumbar spine was conducted to determine the entry point and to evaluate the placement accuracy.
The accuracy of placement was 88.2% in convexity and 84.5% in concavity for the "Free Hand" group, and 94.1% in convexity and 94% in concavity for the "Assisted Free Hand" group. Evidence showed that "Assisted Free Hand" group had higher accuracy when screws were placed in the thoracic spine (P = 0.02), while no obvious difference was seen in the lumbar spine placement (P = 0.47).
We conclude that in the surgical treatment of severe scoliosis, individual screw placement guided by entry points determined by CT reconstruction can result in improved accuracy and ease of the procedure.
通过计算机断层扫描（CT）三维（3D）重建，确定个体化椎弓根螺钉在特发性脊柱侧凸手术治疗中的理想进钉点。
采用“徒手技术”和“辅助徒手技术”对两组 20 例中重度特发性脊柱侧凸患者进行手术治疗。对胸腰椎进行 CT 扫描及 3D 重建，确定进钉点并评估其置钉准确性。
“徒手”组凸侧置钉准确率为 88.2%，凹侧置钉准确率为 84.5%；“辅助徒手”组凸侧置钉准确率为 94.1%，凹侧置钉准确率为 94%。结果表明，“辅助徒手”组在胸椎置钉时准确率更高（P=0.02），而腰椎置钉时差异无统计学意义（P=0.47）。
我们认为，在严重脊柱侧凸的手术治疗中，通过 CT 重建确定进钉点来指导个体化螺钉的放置，可以提高手术的准确性和简易性。
