Chapman Todd M, Blizzard Daniel J, Brown Christopher R
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Eur Spine J. 2016 Jun;25(6):1781-6. doi: 10.1007/s00586-015-4163-z. Epub 2015 Jul 29.
Traditional open exposure for posterior instrumentation requires significant soft tissue mobilization and causes significant blood loss and increased recovery time. Mal-placed screws can injure nerve roots, the spinal cord, viscera, vasculature and the cardiopulmonary system. Placement of pedicle screws using a minimally invasive technique can decrease bleeding risk, damage to soft tissues, and post-operative pain. The purpose of this study is to compare the radiographic accuracy of open free-hand versus percutaneous technique for pedicle screw placement.
Consecutive patients undergoing thoracolumbar surgery from September 2006 to October 2011 with post-operative CT imaging were included in this study. Three-dimensional screw positioning within the pedicle and the vertebral body was assessed on CT. The magnitude and location of violations were measured and recorded. Facet breaches at the cephalad and caudad ends of the construct were documented and graded.
Two-hundred and twenty-three patients met the inclusion criteria for a total of 1609 pedicle screws. Seven-hundred and twenty-four screws were placed using a standard open free-hand technique and 885 were placed percutaneously. There was a significant difference in overall pedicle breach rates: 7.5 % for open and 4.7 % for percutaneous techniques. The magnitude of breach was greater for the percutaneous technique compared to the open technique: 5.4 versus 3.7 mm, respectively. The difference in vertebral body breaches was also significant: 11.3 % for open and 3.6 % for percutaneous. The rates of facet breach did not significantly differ.
This is the largest series comparing the accuracy of percutaneous to open pedicle screw placement. The rates of pedicle, vertebral body, and facets breaches in the percutaneous group were similar to the rates in the open technique group as well as rates reported in the literature. This demonstrates that the percutaneous technique described here is an accurate alternative to standard open free-hand technique.
传统的后路内固定开放显露需要广泛的软组织松解，会导致大量失血并延长恢复时间。螺钉位置不当可能损伤神经根、脊髓、内脏、血管和心肺系统。采用微创技术置入椎弓根螺钉可降低出血风险、减少软组织损伤并减轻术后疼痛。本研究的目的是比较开放徒手与经皮技术置入椎弓根螺钉的影像学准确性。
本研究纳入了2006年9月至2011年10月接受胸腰椎手术且术后有CT影像的连续患者。通过CT评估椎弓根和椎体内的三维螺钉位置。测量并记录侵犯的程度和位置。记录并分级内固定结构头端和尾端的小关节侵犯情况。
223例患者符合纳入标准，共置入1609枚椎弓根螺钉。采用标准开放徒手技术置入724枚螺钉，经皮置入885枚螺钉。总体椎弓根侵犯率有显著差异：开放技术为7.5%，经皮技术为4.7%。与开放技术相比，经皮技术的侵犯程度更大：分别为5.4 mm和3.7 mm。椎体侵犯的差异也很显著：开放技术为11.3%，经皮技术为3.6%。小关节侵犯率无显著差异。
这是比较经皮与开放椎弓根螺钉置入准确性的最大系列研究。经皮组的椎弓根、椎体和小关节侵犯率与开放技术组以及文献报道的率相似。这表明本文所述的经皮技术是标准开放徒手技术的一种准确替代方法。
