Ulutaş Murat, Seçer Mehmet, Çelik Suat Erol
Department of Neurosurgery, Sanko University Hospital , Gaziantep, Turkey.
Department of Neurosurgery, Şehitkamil State Hospital , Gaziantep, Turkey.
Orthop Rev (Pavia). 2015 Mar 24;7(1):5661. doi: 10.4081/or.2015.5661. eCollection 2015 Mar 3.
We prospectively assessed the feasibility and safety of a new percutaneous pedicle screw (PPS) fixation technique for instrumentation of the thoracic and lumbar spine in this study. All patients were operated in the prone position under general anesthesia. A 6 to 8 cm midline skin incision was made and wide subcutaneous dissection was performed. The paravertebral muscles were first dissected subperiosteally into the midline incision of the fascia for lumbar microdiscectomy with transforaminal lumbar interbody fusion cage implantation. After the secondary paramedian incisions on the fascia, the PPSs were inserted via cleavage of the multifidus muscles directly into the pedicles under fluoroscopy visualization. A total of 35 patients underwent surgery with this new surgical technique. The control group for operative time, blood loss and analgesic usage consisted of 35 randomly selected cases from our department. The control group underwent surgery via conventional pedicle screw instrumentation with paramedian fusion. All patients in the minimal invasive surgery series were ambulatory with minimal pain on the first postoperative day. The operation time and blood loss and the postoperative analgesic consumption were significantly less with this new technique. In conclusion, the minimal invasive mini open split-muscular percutaneous pedicle screw fixation technique is safe and feasible. It can be performed via a short midline skin incision and can also be combined with interbody fusion, causing minimal pain without severe muscle damage.
在本研究中，我们前瞻性地评估了一种用于胸腰椎内固定的新型经皮椎弓根螺钉（PPS）固定技术的可行性和安全性。所有患者均在全身麻醉下俯卧位接受手术。做一个6至8厘米的中线皮肤切口，并进行广泛的皮下剥离。首先将椎旁肌骨膜下剥离至筋膜的中线切口，用于经椎间孔腰椎椎间融合器植入的腰椎显微椎间盘切除术。在筋膜上做二次旁正中切口后，在荧光透视下通过多裂肌劈开将PPS直接插入椎弓根。共有35例患者接受了这种新的手术技术。手术时间、失血量和镇痛药物使用的对照组由从我们科室随机选取的35例病例组成。对照组通过传统的椎弓根螺钉内固定及旁正中融合进行手术。微创手术系列中的所有患者在术后第一天即可下床活动，疼痛轻微。与新技术相比，手术时间、失血量和术后镇痛药物消耗量明显更少。总之，微创小切口劈开肌肉经皮椎弓根螺钉固定技术是安全可行的。它可以通过短的中线皮肤切口进行，也可以与椎间融合相结合，在不造成严重肌肉损伤的情况下使疼痛最小化。
