Junaid Muhammad, Afzal Ali, Kalsoom Anisa, Bukhari Syed Sarmad
Dr. Muhammad Junaid, FCPS IFAANS, Department of Neurosurgery, PNS Shifa Hospital, Karachi, Pakistan.
Dr. Ali Afzal, FCPS, Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Pak J Med Sci. 2019;35(3):680-684. doi: 10.12669/pjms.35.3.981.
To determine outcome of freehand pedicle screw fixation for dorsal, lumbar and sacral fractures at a tertiary care centre in the developing world.
A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation from January 1, 2012 to 31 December 2017. A total of 751 pedicle screws were placed. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography.
Among the total 751 free hand placed pedicle screws, four screws (0.53%) were repositioned due to a misdirected trajectory towards the disc space. six screws (0.79%) were identified to have cause moderate breach while four screws (0.53%) cause severe breach. There was no occurrence of iatrogenic nerve root damage or violation of the spinal canal.
Free hand pedicle screw placement based on external landmarks showed remarkable safety and accuracy in our center. The authors conclude that assiduous adherence to technique and preoperative planning is vital to success.
确定在发展中国家一家三级医疗中心，徒手椎弓根螺钉固定术治疗胸、腰及骶骨骨折的效果。
对2012年1月1日至2017年12月31日期间连续接受椎弓根螺钉固定术的150例患者进行回顾性研究。共植入751枚椎弓根螺钉。通过术中及术后X线片和/或计算机断层扫描来确定误置椎弓根螺钉导致皮质骨破损的发生率和程度。
在总共751枚徒手植入的椎弓根螺钉中，4枚螺钉（0.53%）因向椎间盘间隙的轨迹错误而重新定位。6枚螺钉（0.79%）导致中度破损，4枚螺钉（0.53%）导致严重破损。未发生医源性神经根损伤或椎管侵犯。
在我们中心，基于外部标志的徒手椎弓根螺钉置入显示出显著的安全性和准确性。作者得出结论，严格遵守技术和术前规划对成功至关重要。
