Kojima Atsushi, Fujii Atsushi, Morioka Shigeta, Torii Yoshiaki, Arai Kenichiro, Sasao Yutaka
Spine Center, Funabashi Orthopaedic Hospital, Chiba, Japan.
Department of Orthopaedic Surgery, Saint Joseph's Hospital, Kanagawa, Japan.
Spine Surg Relat Res. 2018 Jan 27;2(1):60-64. doi: 10.22603/ssrr.2017-0029. eCollection 2018.
This study compared traditional manual methods and power tool use with regard to the speed and accuracy of percutaneous pedicle screw (PPS) placement and determined the advantages associated with the use of power tools. Although the indication of PPS placement in minimally invasive spine stabilization (MISt) procedures has been recently expanded, there are no reports on PPS insertion using a power tool.
We evaluated 35 patients who underwent PPS insertion using a power tool during MISt procedures. On one side, PPS insertion was performed using the manual (M) method, whereas on the contralateral side, insertion was performed using the power tool (P) method. We assessed the number of implanted PPSs, time taken to implant PPSs after guidewire insertion, and accuracy of PPS placement as ranked postoperatively using computed tomography images.
A total of 294 PPSs were inserted (147 using the M method and 147 using the P method). The mean PPS insertion time was 10.5 s using the P method and 27.4 s using the M method. The time required for inserting a screw using the P method remained consistent in the range of 10-15 s, whereas the time using the M method tended to increase from the second screw onward, with a range of 25-30 s. With regard to PPS insertion accuracy, a 2 mm or more pedicle breach was noted in 2 (1.4%) case after the P method and in 2 (1.4%) case after the M method.
PPS placement using power tools has the potential to save the surgical time during MISt procedures.
本研究比较了传统手工方法和电动工具在经皮椎弓根螺钉（PPS）置入的速度和准确性方面的差异，并确定了使用电动工具的优势。尽管最近微创脊柱稳定（MISt）手术中PPS置入的适应证有所扩大，但尚无关于使用电动工具进行PPS置入的报道。
我们评估了35例在MISt手术中使用电动工具进行PPS置入的患者。一侧采用手工（M）方法置入PPS，而对侧采用电动工具（P）方法置入。我们评估了植入的PPS数量、导丝插入后植入PPS所需的时间，以及使用计算机断层扫描图像术后评估的PPS置入准确性。
共置入294枚PPS（M方法147枚，P方法147枚）。P方法的平均PPS置入时间为10.5秒，M方法为27.4秒。使用P方法插入一枚螺钉所需的时间在10 - 15秒范围内保持一致，而使用M方法的时间从第二枚螺钉开始趋于增加，范围为25 - 30秒。关于PPS置入准确性，P方法后有2例（1.4%）出现2毫米或更大的椎弓根穿破，M方法后也有2例（1.4%）出现。
在MISt手术中使用电动工具置入PPS有可能节省手术时间。
