在无影像导航情况下安全准确地置入胸椎和胸腰椎经皮椎弓根螺钉
Safe and accurate placement of thoracic and thoracolumbar percutaneous pedicle screws without image-navigation.
作者信息
Nimjee Shahid M, Karikari Isaac O, Carolyn A Hardin A B, Choi Jonathan, Powers Ciaran J, Brown Christopher R, Isaacs Robert E
机构信息
Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA.
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
出版信息
Asian J Neurosurg. 2015 Oct-Dec;10(4):272-5. doi: 10.4103/1793-5482.162700.
BACKGROUND
Percutaneous pedicle screw placement is now commonly used to treat spinal instability. It is imperative, especially at thoracic levels, to avoid damage to adjacent neurovascular structures. Although more technically demanding when compared with the lumbar spine, we believe that the percutaneous placement of thoracic pedicle screws can be performed safely without image-navigation.
PURPOSE
The purpose was to evaluate the safety of percutaneous pedicle screw placement in the thoracic and thoracolumbar spine without image-navigation.
STUDY DESIGN/SETTING: A retrospective study at a single institution.
PATIENT SAMPLE
Patients over the age of 18 years who presented with degenerative disease, trauma or tumor that required surgical stabilization.
OUTCOME MEASURES
Our outcomes included postoperative plain film X-rays and computerized tomography (CT).
MATERIALS AND METHODS
We performed a retrospective study of patients who underwent percutaneous pedicle screw placement without image-navigation between T2 and L2.
RESULTS
Between 2005 and 2011, a total of 507 pedicle screws were placed in 120 patients. The indications included trauma (17%), tumor (8%), and degenerative conditions (75%). The mean age was 61.3 years (range: 20-81 years). Fifty-seven percent were male, and 43% were female. The mean blood loss was 297 ± 40 ml. All patients underwent postoperative anterior-posterior and lateral films that showed safe placement of pedicle screws. Moreover, 57% of patients underwent postoperative CT imaging. There was 1 (0.4%) medial breach and 13 (5%) lateral breaches of the pedicle screw patients who underwent CT imaging as read by an independent neuroradiologist. None of the breaches resulted in adverse neurological sequelae either immediately after or at most recent follow-up.
CONCLUSION
Thoracic and thoracolumbar percutaneous pedicle screw placement can be performed safely and accurately without image-navigation.
背景
经皮椎弓根螺钉置入术目前常用于治疗脊柱不稳。尤其是在胸椎节段，必须避免损伤相邻的神经血管结构。尽管与腰椎相比技术要求更高，但我们认为在没有影像导航的情况下，经皮置入胸椎椎弓根螺钉也可安全进行。
目的
评估在没有影像导航的情况下经皮置入胸椎和胸腰椎椎弓根螺钉的安全性。
研究设计/地点：在一家机构进行的回顾性研究。
患者样本
年龄超过18岁，因退行性疾病、创伤或肿瘤需要手术稳定治疗的患者。
观察指标
我们的观察指标包括术后X线平片和计算机断层扫描（CT）。
材料与方法
我们对在T2至L2节段未使用影像导航进行经皮椎弓根螺钉置入术的患者进行了回顾性研究。
结果
2005年至2011年期间，共对120例患者置入了507枚椎弓根螺钉。适应证包括创伤（17%）、肿瘤（8%）和退行性疾病（75%）。平均年龄为61.3岁（范围：20 - 81岁）。男性占57%，女性占43%。平均失血量为297±40 ml。所有患者术后均进行了前后位和侧位X线检查，显示椎弓根螺钉置入安全。此外，57%的患者进行了术后CT成像。经独立神经放射科医生解读，在接受CT成像的椎弓根螺钉患者中，有1例（0.4%）出现内侧穿破，13例（5%）出现外侧穿破。这些穿破在术后即刻或最近一次随访时均未导致不良神经后遗症。
结论
在没有影像导航的情况下，胸椎和胸腰椎经皮椎弓根螺钉置入术可安全、准确地进行。
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