Mombell Kyle W, Waldron Jacob E, Morrissey Patrick B, Saldua Nelson S
Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, USA.
Orthopaedic Spine Surgery, The Vancouver Clinic, Vancouver, USA.
Cureus. 2019 Jun 21;11(6):e4966. doi: 10.7759/cureus.4966.
To determine if the skin incision for lumbar percutaneous pedicle screws should be more lateral in the obese patient.
This was a retrospective radiographic analysis of 30 obese and non-obese lumbar spine computed tomography (CT) radiographs comparing the depth of soft tissue along the anatomic axis of the pedicle at L4 and L5.
The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L4 was 1.4 cm and 3.8 cm in the non-obese and obese groups, respectively. The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L5 was 2.1 cm and 4.3 cm in the non-obese and obese groups, respectively; both these differences reached statistical significance, p <0.05.
This radiographic study supports a more lateral start point for percutaneous pedicle screws in obese patients to maintain an anatomic trajectory when inserting percutaneous pedicle screws into the lumbar spine at L4 and L5. If a skin incision is made at only 1 cm lateral to the pedicle in the obese patient, the surgeon often has to place significant traction on the skin edge to lateralize their instrumentation to achieve an appropriate angle of insertion. By making a more lateral skin incision, less manipulation of the skin and soft tissues is needed to maintain an anatomic trajectory of the pedicle screw. Decreasing soft tissue manipulation may decrease wound and instrumentation complications in this at-risk population.
确定肥胖患者腰椎经皮椎弓根螺钉的皮肤切口是否应更偏向外侧。
这是一项对30例肥胖和非肥胖患者的腰椎计算机断层扫描（CT）影像进行的回顾性影像学分析，比较了L4和L5椎体椎弓根解剖轴线上软组织的深度。
在L4椎体，非肥胖组和肥胖组从皮肤椎弓根轨迹到椎弓根外侧缘的平均距离分别为1.4 cm和3.8 cm。在L5椎体，非肥胖组和肥胖组从皮肤椎弓根轨迹到椎弓根外侧缘的平均距离分别为2.1 cm和4.3 cm；这两个差异均具有统计学意义，p<0.05。
这项影像学研究支持肥胖患者在经皮向L4和L5椎体置入椎弓根螺钉时，为维持解剖轨迹应采用更偏外侧的起始点。如果在肥胖患者椎弓根外侧仅1 cm处做皮肤切口，术者往往需要对皮肤边缘施加较大牵引力，以使器械向外侧移动以获得合适的插入角度。通过做更偏外侧的皮肤切口，维持椎弓根螺钉解剖轨迹所需的皮肤和软组织操作更少。减少软组织操作可能会降低这一高危人群的伤口和器械相关并发症。
