经皮“无克氏针”椎弓根螺钉固定技术：对100枚螺钉的初步经验评估，包括准确性、辐射暴露及手术时间评估
Percutaneous "K-wireless" pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time.
作者信息
Spitz Steven M, Sandhu Faheem A, Voyadzis Jean-Marc
机构信息
Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
出版信息
J Neurosurg Spine. 2015 Apr;22(4):422-31. doi: 10.3171/2014.11.SPINE14181. Epub 2015 Feb 6.
OBJECT
Percutaneous pedicle screws are used to provide rigid internal fixation in minimally invasive spinal procedures and generally require the use of Kirchner wires (or K-wires) as a guide for screw insertion. K-wires can bend, break, advance, or pull out during the steps of pedicle preparation and screw insertion. This can lead to increased fluoroscopic and surgical times and potentially cause neurological, vascular, or visceral injury. The authors present their experience with a novel "K-wireless" percutaneous pedicle screw system that eliminates the inherent risks of K-wire use.
METHODS
A total of 100 screws were placed in 28 patients using the K-wireless percutaneous screw system. Postoperative dedicated spinal CT scans were performed in 25 patients to assess the accuracy of screw placement. Screw placement was graded A through D by 2 independent radiologists: A = within pedicle, B = breach < 2 mm, C = breach of 2-4 mm, and D = breach > 4 mm. Screw insertion and fluoroscopy times were also recorded in each case. Clinical complications associated with screw insertion were documented.
RESULTS
A total of 100 K-wireless percutaneous pedicle screws were placed into the lumbosacral spine in 28 patients. Postoperative CT was performed in 25 patients, thus the placement of only 90 screws was assessed. Eighty-seven screws were placed within the pedicle confines (Grade A), and 3 violated the pedicle (2 Grade B [1 lateral, 1 medial] and 1 Grade D [medial]) for an overall accuracy rate of 96.7%. One patient required reoperation for screw repositioning due to a postoperative L-5 radiculopathy secondary to a Grade D medial breach at L-5. This patient experienced improvement of the radiculopathy after reoperation. Average screw insertion and fluoroscopy times were 6.92 minutes and 22.7 seconds per screw, respectively.
CONCLUSIONS
The results of this study demonstrate that the placement of K-wireless percutaneous pedicle screws is technically feasible and can be performed accurately and safely with short procedure and fluoroscopy times.
目的
经皮椎弓根螺钉用于微创脊柱手术中提供坚强的内固定，通常需要使用克氏针（或K针）作为螺钉置入的导向。在椎弓根准备和螺钉置入步骤中，克氏针可能会弯曲、折断、前进或拔出。这可能会导致透视时间和手术时间增加，并有可能导致神经、血管或内脏损伤。作者介绍了他们使用一种新型“无克氏针”经皮椎弓根螺钉系统的经验，该系统消除了使用克氏针的固有风险。
方法
使用无克氏针经皮螺钉系统为28例患者共置入100枚螺钉。25例患者术后进行了专门的脊柱CT扫描，以评估螺钉置入的准确性。2名独立放射科医生将螺钉置入情况分为A至D级：A = 在椎弓根内，B = 突破<2 mm，C = 突破2 - 4 mm，D = 突破>4 mm。每种情况还记录了螺钉置入时间和透视时间。记录与螺钉置入相关的临床并发症。
结果
28例患者共在腰骶部脊柱置入100枚无克氏针经皮椎弓根螺钉。25例患者进行了术后CT检查，因此仅评估了90枚螺钉的置入情况。87枚螺钉置入椎弓根范围内（A级），3枚突破椎弓根（2枚B级[1枚外侧，1枚内侧]和1枚D级[内侧]），总体准确率为96.7%。1例患者因L5处D级内侧突破导致术后L5神经根病而需要再次手术重新定位螺钉。该患者再次手术后神经根病有所改善。平均每枚螺钉的置入时间和透视时间分别为6.92分钟和22.7秒。
结论
本研究结果表明，无克氏针经皮椎弓根螺钉置入在技术上是可行的，并且可以在手术时间和透视时间较短的情况下准确、安全地进行。
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