Zhang Di, Gao Xianda, Jiang Jiang, Shen Yong, Ding Wenyuan, Cui Huixian
Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
Department of Anatomy, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050017, China.
Int Orthop. 2018 Mar;42(3):567-573. doi: 10.1007/s00264-018-3806-1. Epub 2018 Feb 2.
This study aims to find a safe and easy-to-perform strategy for lumbar pedicle screw insertion based on anatomical landmarks.
From March 2011 to January 2012, 74 patients underwent posterior lumbar interbody fusion or transforaminal lumbar interbody fusion using the new-designed screw insertion technique. During the operation, the entry site for screw insertion was on the outer edge of the superior facet joint, 4 mm downward from upper border of processus transversus. A connecting line between superior and inferior facet joints was used to determine the direction of screw insertion. Postoperative radiograph and computed tomography (CT) were taken routinely to show the position of the screws. Functional outcomes were evaluated using Oswestry Disability Index score, Japanese Orthopedic Association score, and Visual Analogue Scale, respectively.
Sixty-two patients (27 males and 35 females, average age 58.95 ± 8.45) finished the follow-up visit with an average of 46.03 months (36-60). The mean operation time and the blood loss were 169.60 ± 41.21 min and 489.52 ± 189.38 ml, respectively. A total of 274 pedicle screws were inserted following the new technique. According to Lothar Wiesner's classification, 11 screws (4.01%) caused minor violation into wall, two screws (0.73%) caused moderate violation, and other screws were in proper position.
A new-designed surgical strategy for pedicle screw insertion of lumbar spine was introduced and performed, which featured a series of original and easily distinguished landmarks. Clinical application demonstrated the safety and effectiveness of this novel technique for pedicle screw insertion.
本研究旨在基于解剖标志找到一种安全且易于实施的腰椎椎弓根螺钉置入策略。
2011年3月至2012年1月，74例患者采用新设计的螺钉置入技术接受了后路腰椎椎间融合术或经椎间孔腰椎椎间融合术。手术过程中，螺钉置入的进针点位于上关节突外缘，横突上缘向下4毫米处。用上、下关节突之间的连线确定螺钉置入方向。术后常规拍摄X线片和计算机断层扫描（CT）以显示螺钉位置。分别使用Oswestry功能障碍指数评分、日本骨科协会评分和视觉模拟量表评估功能结果。
62例患者（男27例，女35例，平均年龄58.95±8.45岁）完成随访，平均随访时间为46.03个月（36 - 60个月）。平均手术时间和失血量分别为169.60±41.21分钟和489.52±189.38毫升。按照新技术共置入274枚椎弓根螺钉。根据洛塔尔·维斯纳分类法，11枚螺钉（4.01%）造成轻微穿破骨壁，2枚螺钉（0.73%）造成中度穿破，其他螺钉位置合适。
介绍并实施了一种新设计的腰椎椎弓根螺钉置入手术策略，该策略具有一系列原始且易于区分的标志。临床应用证明了这种新型椎弓根螺钉置入技术的安全性和有效性。
