Qiao Jun, Zhu Feng, Xu Leilei, Liu Zhen, Sun Xu, Qian Bangping, Jiang Qing, Zhu Zezhang, Qiu Yong
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China.
Department of Orthopedics, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
BMC Musculoskelet Disord. 2017 Mar 21;18(1):123. doi: 10.1186/s12891-017-1490-8.
There is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome.
CT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1-4.0 mm as Grade 2, 4.1-6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable.
976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P < 0.05), higher in lumbar region than in thoracic region (34.1% VS. 22.3%, P < 0.05) and higher in concave side than in convex side (33.5% VS. 21.9%, P < 0.05). No injury of visceral organs especially aorta erosion was noted in the series. 7 cases of dural tear caused by misplaced screws occurred, and 4 cases developed cerebro-spinal fluid leak. Drainage and pressure dressings were applied for these patients, and no infection was observed. Leg pain was observed in 7 cases, and 2 cases simultaneously complained of leg weakness. Revision surgery was conducted to remove the misplaced screws for these 2 patients. Conservative treatment was applied for the 5 patients without leg weakness. Symptoms of leg weakness and pain resolved in all patients.
Placement of pedicle screw in Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.
目前尚无关于马凡综合征中椎弓根螺钉置入安全性和准确性的研究。本研究的目的是探讨马凡综合征相关脊柱侧弯中椎弓根螺钉置入的准确性和安全性。
进行CT扫描以分析椎弓根螺钉置入的准确性。椎弓根穿孔分为内侧、外侧或前方，并分为四个等级：≤2mm为1级，2.1 - 4.0mm为2级，4.1 - 6.0mm为3级，≥6.1mm为4级。完全置入椎弓根内的螺钉或内侧壁穿孔≤2mm或外侧壁穿孔≤6mm且未损伤内脏器官的螺钉被认为是可接受的，否则为不可接受。
共置入976枚椎弓根螺钉，713枚（73.1%）完全位于椎弓根皮质边界内。924枚（94.7%）螺钉被认为是可接受的，52枚（5.3%）为不可接受。徒手技术的穿孔率高于O型臂导航技术（30.8%对vs. 11.4%，P < 0.05），腰椎区域高于胸椎区域（34.1%对vs. 22.3%，P < 0.05），凹侧高于凸侧（33.5%对vs. 21.9%，P < 0.05）。该系列中未发现内脏器官损伤，尤其是主动脉侵蚀。发生7例因螺钉位置不当导致的硬脑膜撕裂，4例出现脑脊液漏。对这些患者进行了引流和加压包扎，未观察到感染。7例出现腿痛，2例同时伴有腿部无力。对这2例患者进行了翻修手术以取出位置不当的螺钉。对5例无腿部无力的患者进行了保守治疗。所有患者的腿部无力和疼痛症状均得到缓解。
马凡综合征中椎弓根螺钉置入是准确且安全的。O型臂导航是确保螺钉置入安全性和准确性的有效方式。在腰椎和脊柱畸形凹侧置入螺钉时应特别注意，以避免较高的并发症发生率。
