颈椎椎弓根螺钉置入的混合技术：微创手术与经皮套管系统联合应用的初步研究
Hybrid Technique for Cervical Pedicle Screw Placement: Combination of Miniopen Surgery and Use of a Percutaneous Cannula System-Pilot Study.
作者信息
Kim Moon-Kyu, Cho Sung-Min, You Seung-Hoon, Kim In-Beom, Kwak Dai-Soon
机构信息
*Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea †Department of Neurosurgery, Donghae Dong-In Hospital, Donghae, Korea; and ‡Catholic Institute for Applied Anatomy/Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea.
出版信息
Spine (Phila Pa 1976). 2015 Aug 1;40(15):1181-6. doi: 10.1097/BRS.0000000000000986.
STUDY DESIGN
Cadaver study and clinical application; a pilot study.
OBJECTIVE
To minimize muscle dissection and enhance accuracy of cervical pedicle screw (CPS) placement by using a percutaneous cannula system.
SUMMARY OF BACKGROUND DATA
Many studies have reported that the most frequent misplacement of CPSs is breach of the lateral wall; thus, an easy technique for securing medial convergence is required. We developed a percutaneous cannula system for this purpose and report the results of a cadaver study and its clinical application.
METHODS
A cadaver study was conducted to confirm the possibility of this percutaneous technique in 5 specimens (50 CPSs, C3-C7). Then, the technique was applied in 8 patients (40 CPSs, C3-C7). The surgical technique was a hybrid of miniopen surgery and the use of percutaneous cannula system under lateral fluoroscopic guidance. Entry holes were made in the open field and a cannula was used for tapping and insertion of CPSs. A stiff pedicle probe through the cannula was used to locate the pedicle in the lateral mass.
RESULTS
In the cadaver study, there were 12 (24%) misplacements among 50 CPSs used. The hybrid technique was applied clinically in 4 traumatic, 2 degenerative, and 2 failed back surgery lesions. Thirty CPSs were inserted using the percutaneous cannula system and 10 were inserted using a cannula as a retractor. Misplacement occurred in 6.7% (n = 2) and 20% (n = 2) pedicles, respectively, and there were no symptomatic complications (total incidence, 10%). An additional incision for the cannula system can be made for 2-level CPS insertions.
CONCLUSION
Use of the percutaneous cannula system facilitated a secure convergence angle for CPS insertion without extending muscle dissection or shifting cervical alignment because of muscle retraction. Moreover, this system can be used for CPS insertion in bull-necked patients.
LEVEL OF EVIDENCE
研究设计
尸体研究与临床应用；一项初步研究。
目的
通过使用经皮套管系统，尽量减少肌肉解剖并提高颈椎椎弓根螺钉（CPS）置入的准确性。
背景资料总结
许多研究报告称，CPS最常见的放置错误是穿破侧壁；因此，需要一种确保向内侧汇聚的简便技术。我们为此开发了一种经皮套管系统，并报告尸体研究结果及其临床应用情况。
方法
进行尸体研究以确认该经皮技术在5个标本（50枚CPS，C3 - C7）中的可行性。然后，将该技术应用于8例患者（40枚CPS，C3 - C7）。手术技术是微创开放手术与在侧位透视引导下使用经皮套管系统的结合。在开放视野中制作入口孔，并使用套管进行攻丝和CPS置入。通过套管使用硬椎弓根探子在侧块中定位椎弓根。
结果
在尸体研究中，所使用的50枚CPS中有12枚（24%）放置错误。该混合技术临床应用于4例创伤性、2例退行性和2例腰椎手术失败综合征病变。使用经皮套管系统置入30枚CPS，使用套管作为牵开器置入10枚。椎弓根放置错误分别发生在6.7%（n = 2）和20%（n = 2），且无有症状的并发症（总发生率为10%）。对于双节段CPS置入，可额外制作一个用于套管系统的切口。
结论
使用经皮套管系统有助于为CPS置入提供安全的汇聚角度，而不会因肌肉牵拉而扩大肌肉解剖范围或改变颈椎对线。此外，该系统可用于短粗颈患者的CPS置入。
证据级别
3级。
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