Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China.
Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China.
J Clin Neurosci. 2019 Nov;69:265-268. doi: 10.1016/j.jocn.2019.07.077. Epub 2019 Aug 28.
Percutaneous pedicle screws have been used in the treatment of thoracolumbar fractures for decades, and conventional fluoroscopy is commonly used to confirm the positions of the Jamshidi needles during the procedure. In this article, a modified method is reported for the placement of Jamshidi needles. The attending surgeons did not receive any radiation during the procedure and the fluoroscopy time for the patients was little. In our method, all six Jamshidi needles were placed on the pedicles and hammered 2 mm into each entry site. When the verification images were acquired, the medical personnel went behind a lead-lined wall. The positions of the needles were first reviewed and adjusted as needed based on the anterior-posterior (AP) image. Then, the C-arm was rotated and lateral images were obtained to further verify the needle placement. The rest of the screw placement procedure remained the same. The proposed technique was applied in 45 patients with thoracolumbar fractures. It took an average (range) of 5 (4-7) single-shot images to ensure all the needles were positioned at the ideal entry site and 12 (10-17) minutes to complete this step. No neurological symptoms were reported by the patients. Using the proposed technique, the radiation exposure for the surgeons is zero, and the patients are well-protected from excessive radiation exposure. This modified method of embedding all the Jamshidi needles at the entry sites before fluoroscopy is an improved technique compared with the conventional method.
经皮椎弓根螺钉技术已在胸腰椎骨折的治疗中应用了数十年，通常使用传统的透视来确认置钉过程中Jamshidi 针的位置。本文报告了一种改良的 Jamshidi 针置钉方法。术者在手术过程中未接受任何辐射，患者的透视时间也很短。在我们的方法中，所有六根 Jamshidi 针都被放置在椎弓根上，并向每个进钉点锤入 2mm。当获取验证图像时，医务人员会走到铅屏风后面。首先根据前后位（AP）图像对针的位置进行评估和必要的调整。然后，旋转 C 臂以获取侧位图像，以进一步验证针的位置。其余的螺钉放置过程保持不变。该技术已应用于 45 例胸腰椎骨折患者。平均（范围）需要 5（4-7）张单次拍摄的图像来确保所有的针都位于理想的进钉点，完成这一步骤需要 12（10-17）分钟。患者未报告任何神经症状。使用该技术，术者的辐射暴露为零，患者也能免受过度辐射的影响。与传统方法相比，在透视前将所有 Jamshidi 针预置于进钉点的改良方法是一种改进的技术。
