Bai Yu-Shu, Niu Yun-Fei, Chen Zi-Qiang, Zhu Xiao-Dong, Gabriel Liu Ka Po, Wong Hee Kit, Li Ming
Department of Orthopedic Surgery, Changhai Hospital, Shanghai, PR China.
J Spinal Disord Tech. 2013 Aug;26(6):316-20. doi: 10.1097/BSD.0b013e318247f21d.
Prospective randomized clinical trial.
To compare the accuracy and time using of pedicle screw placement between electronic conductivity device (ECD) and normal pedicle finder (NPF) in posterior surgery of scoliosis, through a randomized clinical trial.
Pedicle screw insertion for scoliosis correction can be associated with increased pedicle perforations. The malposition rates using various techniques in different region of the spine have been reported to occur with a frequency of 3.3%-43%. An ECD has been reported in spine surgeries, but its accuracy and surgical time comparing with NPF in the presence of scoliosis has not been reported.
The 42 patients of adolescent idiopathic scoliosis with average major Cobb angle of 55.3±7 degrees (range, 45-78 degrees), who received posterior correction surgeries using pedicle screws system only were divided into 2 groups by random: group NPF (22 patients); and group ECD (20 patients). NPF group had 332 screws and ECD group had 362 screws. The 2 groups were compared for accuracy of screw placement, time for screw insertion, and the number of times the C-arm had to be brought into the field.
There were 47 (14.2%) pedicle perforation in the NPF group as compared with only 15 (4.1%) in the ECD group (P<0.001). Although in different region of the spine, screw accuracy showed discrepant statistical result, with upper (T1-T3), middle (T4-T7), and lower thoracic (T8-T10) comparison showing significant statistical difference (P=0.010, 0.001, and 0.041, respectively) and thoracolumbar (T11-L2) and lower lumbar (L3-L5) comparison showing no significant statistical difference (P=0.278 and 0.292, respectively). Average screw insertion time in the NPF group was 241±61 seconds compared with 204±33 seconds in the ECD group (P=0.009). The C-arm had to be moved into the operation field on an average of 1.59±0.67 times in the NPF group compared with 1.20±0.52 in the ECD group (P=0.040).
ECD increases pedicle screw accuracy, especially in T1-T10, and reduces insertion time and radiation in posterior adolescent idiopathic scoliosis.
前瞻性随机临床试验。
通过一项随机临床试验，比较电子传导装置（ECD）和普通椎弓根探测器（NPF）在脊柱侧弯后路手术中椎弓根螺钉置入的准确性和用时。
用于脊柱侧弯矫正的椎弓根螺钉置入可能会增加椎弓根穿孔的风险。据报道，在脊柱不同区域使用各种技术时，错位率的发生频率为3.3%-43%。已有报道称在脊柱手术中使用ECD，但尚未报道其在脊柱侧弯情况下与NPF相比的准确性和手术时间。
42例青少年特发性脊柱侧弯患者，平均主 Cobb 角为55.3±7度（范围45-78度），仅接受使用椎弓根螺钉系统的后路矫正手术，随机分为两组：NPF组（22例患者）；ECD组（20例患者）。NPF组有332枚螺钉，ECD组有362枚螺钉。比较两组螺钉置入的准确性、螺钉置入时间以及C形臂进入手术视野的次数。
NPF组有47例（14.2%）椎弓根穿孔，而ECD组仅15例（4.1%）（P<0.001）。尽管在脊柱不同区域，螺钉准确性显示出不同的统计结果，上胸段（T1-T3）、中胸段（T4-T7）和下胸段（T8-T10）比较显示有显著统计学差异（分别为P=0.010、0.001和0.041），胸腰段（T11-L2）和下腰段（L3-L5）比较无显著统计学差异（分别为P=0.278和0.292）。NPF组平均螺钉置入时间为241±61秒，而ECD组为204±33秒（P=0.009）。NPF组C形臂平均进入手术视野1.59±0.67次，而ECD组为1.20±0.52次（P=0.040）。
ECD提高了椎弓根螺钉的准确性，尤其是在T1-T10，并且减少了青少年特发性脊柱侧弯后路手术的置入时间和辐射。
