Kwan M K, Chiu C K, Lee C K, Chan C Y W
University of Malaya, Kuala Lumpur, Malaysia.
Bone Joint J. 2015 Nov;97-B(11):1555-61. doi: 10.1302/0301-620X.97B11.35789.
Percutaneous placement of pedicle screws is a well-established technique, however, no studies have compared percutaneous and open placement of screws in the thoracic spine. The aim of this cadaveric study was to compare the accuracy and safety of these techniques at the thoracic spinal level. A total of 288 screws were inserted in 16 (eight cadavers, 144 screws in percutaneous and eight cadavers, 144 screws in open). Pedicle perforations and fractures were documented subsequent to wide laminectomy followed by skeletalisation of the vertebrae. The perforations were classified as grade 0: no perforation, grade 1: < 2 mm perforation, grade 2: 2 mm to 4 mm perforation and grade 3: > 4 mm perforation. In the percutaneous group, the perforation rate was 11.1% with 15 (10.4%) grade 1 and one (0.7%) grade 2 perforations. In the open group, the perforation rate was 8.3% (12 screws) and all were grade 1. This difference was not significant (p = 0.45). There were 19 (13.2%) pedicle fractures in the percutaneous group and 21 (14.6%) in the open group (p = 0.73). In summary, the safety of percutaneous fluoroscopy-guided pedicle screw placement in the thoracic spine between T4 and T12 is similar to that of the conventional open technique.
经皮椎弓根螺钉置入术是一项成熟的技术，然而，尚无研究比较经皮和开放方式在胸椎置入螺钉的情况。本尸体研究的目的是比较这两种技术在胸椎水平的准确性和安全性。总共在16具尸体中置入了288枚螺钉（8具尸体采用经皮置入，144枚螺钉；8具尸体采用开放置入，144枚螺钉）。在广泛椎板切除及椎体骨骼化后记录椎弓根穿孔和骨折情况。穿孔分为0级：无穿孔；1级：穿孔＜2 mm；2级：穿孔2 mm至4 mm；3级：穿孔＞4 mm。在经皮组，穿孔率为11.1%，其中15枚（10.4%）为1级穿孔，1枚（0.7%）为2级穿孔。在开放组，穿孔率为8.3%（12枚螺钉），均为1级穿孔。差异无统计学意义（p = 0.45）。经皮组有19例（13.2%）椎弓根骨折，开放组有21例（14.6%）（p = 0.73）。总之，在T4至T12胸椎水平，经皮透视引导下椎弓根螺钉置入术的安全性与传统开放技术相似。
