Department of Trauma and Orthopedic Surgery, St. Bernward Krankenhaus, Treibestrasse 9, 31139 Hildesheim, Germany.
Arch Orthop Trauma Surg. 2012 Oct;132(10):1371-7. doi: 10.1007/s00402-012-1555-y. Epub 2012 Jun 15.
The insertion of thoracic pedicle screws (T1-T10) is subject to a relevant rate of malplacement. The optimum implantation procedure is still a topic of controversial debate. Currently, a postoperative computed tomography is required to evaluate the screw positions. The present study was undertaken to clarify whether intraoperative 3D imaging is a reliable method of determining the position of thoracic pedicle screws.
This prospective study involved 40 consecutive patients with thoracic spinal injuries, with intraoperative 3D scans being performed to determine the positions of 240 pedicle screws in T1-T10. The results of the 3D scans were compared with the findings of postoperative CT scans, using a clinical classification system.
The positions of 204 pedicle screws could be viewed by means of both 3D and CT scans and the results compared. The 3D scans achieved a sensitivity of 90.9 % and a specificity of 98.8 %. The rate of misclassification by the 3D scans was 2.5 %. Nine pedicle screws were classified as misplaced and their position corrected intraoperatively (3.8 %). No screws required postoperative revision.
Performing an intraoperative 3D scan enables the position of thoracic pedicle screws to be determined with sufficient accuracy. The rate of revision surgery was reduced to 0 %.
胸椎椎弓根螺钉（T1-T10）的置入存在一定的置钉偏差率。目前，最优的植入程序仍存在争议。术后通常需要进行计算机断层扫描（CT）来评估螺钉位置。本研究旨在探讨术中三维（3D）成像是否为确定胸椎椎弓根螺钉位置的可靠方法。
本前瞻性研究纳入 40 例胸段脊柱损伤患者，术中进行 3D 扫描以确定 T1-T10 节段的 240 枚椎弓根螺钉的位置。使用临床分类系统将 3D 扫描结果与术后 CT 扫描结果进行比较。
通过 3D 和 CT 扫描可观察到 204 枚螺钉的位置，并对结果进行比较。3D 扫描的灵敏度为 90.9%，特异性为 98.8%。3D 扫描的错误分类率为 2.5%。9 枚螺钉被归类为置钉不良，并在术中进行了纠正（3.8%）。无一例螺钉需要术后修正。
术中进行 3D 扫描可使胸椎椎弓根螺钉的位置确定具有足够的准确性。手术修正率降低至 0%。
