Kwan Mun Keong, Chiu Chee Kidd, Chan Chris Yin Wei, Zamani Reza, Hansen-Algenstaedt Nils
1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia.
2 Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany.
J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017722438. doi: 10.1177/2309499017722438.
This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6).
Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm.
There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%).
Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.
本研究分析了透视引导下在上胸椎（T1-T6）置入经皮螺钉的准确性和安全性。
回顾性评估了2008年1月至2012年12月期间74例患者的计算机断层扫描。椎弓根穿孔按两种分级系统进行分类。对于内侧、外侧、上方和下方穿孔：0级——未侵犯；1级——<2mm；2级——2-4mm；3级——>4mm。对于前方穿孔：0级——未侵犯；1级——<4mm；2级——4-6mm；3级——>6mm。
共分析了35例（47.3%）男性和39例（52.7%）女性患者的260枚胸椎椎弓根螺钉（T1-T6）。有32枚螺钉穿孔，穿孔率为12.3%（1级占11.2%，2级占0.7%，3级占0.4%）。无一例导致与椎弓根螺钉相关的并发症。穿孔率在T1最高（33.3%，均为1级穿孔），其次是T6（14.5%）和T4（14.0%）。
透视引导下在上胸椎（T1-T6）置入经皮椎弓根螺钉技术要求更高，且有发生严重并发症的潜在风险。由于T1和T2水平椎弓根内侧角度大以及肩胛带对透视外侧影像的遮挡，以及T4-T6水平椎弓根宽度较小，在这些节段置入透视引导下经皮椎弓根螺钉时需要格外小心。
