Chiu C K, Kwan M K, Chan C Y W, Schaefer C, Hansen-Algenstaedt N
University of Malaya, Kuala Lumpur, Malaysia.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Bone Joint J. 2015 Aug;97-B(8):1111-7. doi: 10.1302/0301-620X.97B8.35330.
We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location.
我们进行了一项回顾性研究，调查在荧光透视引导下于腰骶关节和腰椎置入经皮椎弓根螺钉的准确性和安全性。患者的CT扫描数据来自两个中心：德国汉堡-埃彭多夫大学医学中心的欧洲患者，以及马来西亚马来亚大学的亚洲患者。螺钉穿孔分为0级、1级、2级和3级。对来自203例患者的880枚经皮椎弓根螺钉进行了分析：144例欧洲患者的614枚螺钉和59例亚洲患者的266枚螺钉。患者的平均年龄为58.8岁（16至91岁），其中男性103例，女性100例。穿孔总发生率为9.9%（87枚螺钉），1级穿孔占7.4%，2级穿孔占2.0%，3级穿孔占0.5%。欧洲人的穿孔率为10.4%，亚洲人的穿孔率为8.6%，两者之间无显著差异（p = 0.42）。S1节段的穿孔率最高（19.4%），其次是L5节段（14.9%）。经皮椎弓根螺钉置入的准确性和安全性与文献中报道的开放椎弓根螺钉置入方法相当。由于L5和S1经皮椎弓根螺钉的椎弓根角度更大、椎体解剖变异以及该部位椎管形态的原因，在置入过程中必须格外小心。
