透视引导下经皮胸腰椎及腰骶椎椎弓根螺钉置入的准确性与安全性：2000枚螺钉的回顾性研究

Accuracy and safety of fluoroscopic guided percutaneous pedicle screws in thoracic and lumbosacral spine: a review of 2000 screws.

作者信息

Hansen-Algenstaedt Nils, Chiu Chee Kidd, Chan Chris Yin Wei, Lee Chee Kean, Schaefer Christian, Kwan Mun Keong

机构信息

*Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany †Orthocentrum Hamburg, Department of Spine Surgery, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany ‡Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia; and §Department of Spine Surgery, Rheumaklinik Bad Bramstedt, Oskar Alexander Strasse, Bad Bramstedt, Germany.

出版信息

Spine (Phila Pa 1976). 2015 Sep 1;40(17):E954-63. doi: 10.1097/BRS.0000000000000958.

DOI:10.1097/BRS.0000000000000958

PMID:25929207

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To investigate the accuracy and safety of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracic and lumbosacral spine.

SUMMARY OF BACKGROUND DATA

Several studies had examined the accuracy and safety of percutaneous pedicle screws but provided large variations in their results with small number of patients or few number of pedicle screws evaluated.

METHODS

Computerized tomography of patients who had surgery with fluoroscopic guided percutaneous pedicle screws were chosen from 2 centers: (1) European patients from University Medical Center Hamburg-Eppendorf, Germany and (2) Asian patients from University Malaya Medical Centre, Malaysia. Screw perforations were classified into Grade 0, Grade 1 (<2 mm), Grade 2 (2-4 mm), and Grade 3 (>4 mm).

RESULTS

In total, 2000 percutaneous pedicle screws from 273 patients were analyzed: 1290 screws from 183 European patients and 710 screws from 90 Asian patients. The mean age was 59.1 ± 15.6. There were 140 male patients and 133 female patients. The total perforation rate was 9.4% with 151 (7.5%) Grade 1, 31 (1.6%) Grade 2, and 5 (0.3%) Grade 3 perforations. The total perforation rates among Europeans were 9.4% and among Asians were 9.3%. There was no difference between the 2 groups (P > 0.05). There were 3 distinct peaks in perforation rates (trimodal distribution) at T1, midthoracic region (T4-T7), and lumbosacral junction (L5 and S1). The highest perforation rates were at T1 (33.3%), S1 (19.4%), and T4 (18.6%).

CONCLUSION

Implantation of percutaneous pedicle screws insertion using fluoroscopic guidance is safe and has the accuracy comparable to open techniques of pedicle screws insertion.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性研究。

目的

探讨在胸腰椎和腰骶椎使用透视引导置入经皮椎弓根螺钉的准确性和安全性。

背景资料总结

多项研究已对经皮椎弓根螺钉的准确性和安全性进行了检查，但由于评估的患者数量少或椎弓根螺钉数量少，其结果差异很大。

方法

从2个中心选取接受透视引导下经皮椎弓根螺钉手术的患者的计算机断层扫描资料：（1）德国汉堡-埃彭多夫大学医学中心的欧洲患者；（2）马来西亚马来亚大学医学中心的亚洲患者。螺钉穿孔分为0级、1级（<2mm）、2级（2-4mm）和3级（>4mm）。

结果

共分析了273例患者的2000枚经皮椎弓根螺钉：183例欧洲患者的1290枚螺钉和90例亚洲患者的710枚螺钉。平均年龄为59.1±15.6岁。男性患者140例，女性患者133例。总穿孔率为9.4%，其中1级穿孔151例（7.5%），2级穿孔31例（1.6%），3级穿孔5例（0.3%）。欧洲人的总穿孔率为9.4%，亚洲人的总穿孔率为9.3%。两组之间无差异（P>0.05）。穿孔率有3个明显的峰值（三峰分布），分别位于T1、胸段中部（T4-T7）和腰骶交界处（L5和S1）。穿孔率最高的是T1（33.3%）、S1（19.4%）和T4（18.6%）。