Gruenberg Marcelo, Petracchi Matías, Valacco Marcelo, Solá Carlos
Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Evid Based Spine Care J. 2010 Aug;1(2):11-7. doi: 10.1055/s-0028-1100909.
Retrospective prognostic study.
To evaluate whether patients with anatomical deformity due to scoliosis have a higher frequency of inaccurate pedicle screw insertion and related complications using the free-hand technique compared with those whose normal anatomy had been impacted by trauma.
Consecutively treated trauma patients with otherwise normal anatomy (48 patients instrumented with 291 screws, group A) and scoliosis patients (24 patients instrumented with 287 screws, group B) were evaluated. Screw position on CT was evaluated using the classification by Gertzbein and Robbins with modification by Karagoz Guzey. (See web appendix at www.aospine.org/ebsj for complete classification description.) Images were examined by two fellows and one junior staff member none of whom participated in patient management. Screw position was determined by consensus.
In group A, five (1.7%) out of 289 screws were severely misplaced and 26 (9%) screws caused either medial (3.8%) or lateral (5.2%) cortical breeches. The other 258 (89.3%) screws were fully contained within the cortical boundaries of the pedicle. In group B, seven (2.8%) out of 256 screws were severely misplaced. Thirty-three (13%) screws caused cortical breeches, either medial (9%), lateral (2%), or anterior (2%), and 216 (84.3%) screws were fully contained within the cortical boundaries of the pedicle and the vertebra. Neurological complications were reported in one patient with scoliosis. No vascular complications were reported in either group.
The percentage of incorrectly placed screws was similar in both groups, trauma and deformity patients. The presence of vertebral anatomical changes related to adult scoliosis was not associated with an increase in the screw-related neurological or vascular complications. [Table: see text] The definiton of the different classes of evidence is available on page 73.
回顾性预后研究。
评估与正常解剖结构因创伤而受影响的患者相比，脊柱侧弯导致解剖畸形的患者采用徒手技术时椎弓根螺钉置入不准确及相关并发症的发生率是否更高。
对连续接受治疗的创伤患者（48例，置入291枚螺钉，A组）和脊柱侧弯患者（24例，置入287枚螺钉，B组）进行评估，这些创伤患者的其他解剖结构正常。采用经Karagoz Guzey修改的Gertzbein和Robbins分类法评估CT上的螺钉位置。（完整分类描述见www.aospine.org/ebsj网站附录。）由两名研究员和一名初级工作人员检查图像，他们均未参与患者管理。通过协商确定螺钉位置。
A组，289枚螺钉中有5枚（1.7%）严重位置不当，26枚（9%）螺钉导致内侧（3.8%）或外侧（5.2%）皮质穿孔。其余258枚（89.3%）螺钉完全位于椎弓根皮质边界内。B组，256枚螺钉中有7枚（2.8%）严重位置不当。33枚（13%）螺钉导致皮质穿孔，内侧（9%）、外侧（2%）或前方（2%），216枚（84.3%）螺钉完全位于椎弓根和椎体的皮质边界内。脊柱侧弯患者中有1例报告了神经并发症。两组均未报告血管并发症。
创伤患者和畸形患者两组中螺钉置入错误的百分比相似。与成人脊柱侧弯相关的椎体解剖结构改变与螺钉相关的神经或血管并发症增加无关。[表：见正文]不同证据类别的定义见第73页。
