Weise Lutz, Suess Olaf, Picht Thomas, Kombos Theodoros
Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Med Devices (Auckl). 2008 Jul;1:33-9. doi: 10.2147/mder.s3747. Epub 2008 Oct 13.
Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system.
Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision(®), Stryker). The accuracy of placement was assessed postoperatively by CT scan, and the patients were followed-up clinically for a mean of 16 months.
The total medio-caudal pedicle wall perforation rate was 9.2% (30/326). In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more) was 3.37% (11/326). Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period.
We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary.
椎弓根螺钉常用于脊柱不稳的后路固定且成功率较高，但螺钉置入仍具有挑战性。即便使用导航技术，误置率仍高达11%。本研究旨在评估一种新型椎弓根螺钉系统的准确性。
对67例因肿瘤、创伤、退行性疾病或感染而连续接受胸腰椎融合手术的患者进行研究。使用一种新型的钢丝引导、空心、多轴螺钉系统（XIA Precision(®)，史赛克公司）共置入326枚椎弓根螺钉。术后通过CT扫描评估螺钉置入的准确性，并对患者进行平均16个月的临床随访。
椎弓根壁中尾端总的穿孔率为9.2%（30/326）。在这30例病例中，有19例皮质突破小于2毫米。误置率（定义为穿孔2毫米或以上）为3.37%（11/326）。这11枚螺钉中有3枚因神经症状或脑脊液漏需要手术翻修。在随访期间未出现螺钉断裂或脱位情况。
我们得出结论，在胸腰椎使用这种空心螺钉系统置入椎弓根螺钉是准确且安全的。该技术的优点包括操作简便，无需耗时的准备工作。考虑到长期螺钉断裂的发生率，有必要进行更长随访期的进一步研究。
