Chiu Chee Kidd, Chan Chris Yin Wei, Kwan Mun Keong
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017713938. doi: 10.1177/2309499017713938.
This study investigates the safety and accuracy of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracolumbosacral spine among Asian patients.
Computerized tomography scans of 128 patients who had surgery using fluoroscopic-guided percutaneous pedicle screws were selected. Medial, lateral, superior, and inferior screw perforations were classified into grade 0 (no violation), grade 1 (<2 mm perforation), grade 2 (2-4 mm perforation), and grade 3(>4 mm perforation). Anterior perforations were classified into grade 0 (no violation), grade 1 (<4 mm perforation), grade 2 (4-6 mm perforation), and grade 3(>6 mm perforation). Grade 2 and grade 3 perforation were considered as "critical" perforation.
In total, 1002 percutaneous pedicle screws from 128 patients were analyzed. The mean age was 52.7 ± 16.6. There were 70 male patients and 58 female patients. The total perforation rate was 11.3% (113) with 8.4% (84) grade 1, 2.6% (26) grade 2, and 0.3% (3) grade 3 perforations. The overall "critical" perforation rate was 2.9% (29 screws) and no complications were noted. The highest perforation rates were at T4 (21.6%), T2 (19.4%), and T6 (19.2%).
The total perforation rate of 11.3% with the total "critical" perforation rate of 2.9% (2.6% grade 2 and 0.3% grade 3 perforations). The highest perforation rates were found over the upper to mid-thoracic region. Fluoroscopic-guided percutaneous pedicle screws insertion among Asians has the safety and accuracy comparable to the current reported percutaneous pedicle screws and open pedicle screws techniques.
本研究调查在亚洲患者中，使用荧光镜引导在胸腰段脊柱置入经皮椎弓根螺钉的安全性和准确性。
选取128例行荧光镜引导下经皮椎弓根螺钉手术患者的计算机断层扫描图像。将螺钉的内侧、外侧、上方和下方穿孔分为0级（无侵犯）、1级（穿孔<2mm）、2级（穿孔2 - 4mm）和3级（穿孔>4mm）。前方穿孔分为0级（无侵犯）、1级（穿孔<4mm）、2级（穿孔4 - 6mm）和3级（穿孔>6mm）。2级和3级穿孔被视为“严重”穿孔。
共分析了128例患者的1002枚经皮椎弓根螺钉。平均年龄为52.7±16.6岁。男性患者70例，女性患者58例。总穿孔率为11.3%（113枚），其中1级穿孔率为8.4%（84枚），2级穿孔率为2.6%（26枚），3级穿孔率为0.3%（3枚）。总体“严重”穿孔率为2.9%（29枚螺钉），未观察到并发症。穿孔率最高的部位是T4（21.6%）、T2（19.4%）和T6（19.2%）。
总穿孔率为11.3%，总“严重”穿孔率为2.9%（2级穿孔率为2.6%，3级穿孔率为0.3%）。穿孔率最高的部位在上胸段至中胸段区域。在亚洲人中，荧光镜引导下经皮椎弓根螺钉置入术的安全性和准确性与目前报道的经皮椎弓根螺钉技术和开放椎弓根螺钉技术相当。
