Weinstein J N, Spratt K F, Spengler D, Brick C, Reid S
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Spine (Phila Pa 1976). 1988 Sep;13(9):1012-8. doi: 10.1097/00007632-198809000-00008.
The increased popularity of pedicle fixation prompted research to address two issues: the reliability and validity of roentgenograms as a technique for evaluating the success of pedicle fixation, and the effects of surgical factors on successful fixation. Thus, does approach--the point and angle of screw insertion, surgeon experience, practice, level of the spine involved, and screw size--effect success of pedicle fixation? Eight fresh thoracolumbar spines were harvested and cleaned of all soft tissues. Two surgeons, one more experienced in pedicle fixation than the other, used two pedicle fixation approaches (Weinstein and Roy-Camille) on both the left and right sides at levels T11-S1 of each specimen. All screws were placed under anteroposterior (AP) and lateral c-arm control. For specimens 1 to 3, 5.5 mm screws were used at T11-L1, and 7.0 mm screws at L2-S1. Unacceptable failure rates at L2 and L3 for the first three specimens resulted in a change of instrumentation for the remaining specimens, with 5.5 mm screws used at T11-L3 and 7.0 mm screws at L4-S1. When surgeons completed the fixations for a specimen, AP and lateral roentgenograms were taken and both surgeons independently evaluated the films to assess the success of each fixation. Failure was defined as evidence of any cortical perforation on any side of the pedicle in or outside of the spinal canal. After completing the roentgenogram evaluation, the specimen was transected in the midline, and the success of each pedicle fixation was evaluated by visual/tactile inspection. There were no disagreements between surgeons on the visual/tactile evaluations of the specimens.(ABSTRACT TRUNCATED AT 250 WORDS)
椎弓根固定术日益普及，促使人们开展研究以解决两个问题：X线片作为评估椎弓根固定术成功与否的技术的可靠性和有效性，以及手术因素对成功固定的影响。那么，手术入路——螺钉置入的点和角度、外科医生的经验、实践操作、所涉及的脊柱节段以及螺钉尺寸——是否会影响椎弓根固定术的成功？获取了8个新鲜的胸腰椎脊柱标本，并清除所有软组织。两位外科医生，其中一位在椎弓根固定方面比另一位更有经验，在每个标本的T11 - S1节段的左右两侧采用两种椎弓根固定方法（温斯坦法和罗伊 - 卡米尔法）。所有螺钉均在前后位（AP）和侧位C形臂控制下置入。对于标本1至3，T11 - L1节段使用5.5毫米螺钉，L2 - S1节段使用7.0毫米螺钉。前三个标本在L2和L3节段出现了不可接受的失败率，导致其余标本的器械选择发生改变，T11 - L3节段使用5.5毫米螺钉，L4 - S1节段使用7.0毫米螺钉。当外科医生完成一个标本的固定后，拍摄AP位和侧位X线片，两位外科医生独立评估这些片子以评估每次固定的成功与否。失败定义为椎管内或椎管外椎弓根任何一侧出现皮质穿孔的证据。完成X线片评估后，在标本中线处横断，通过视觉/触觉检查评估每个椎弓根固定的成功情况。在对标本的视觉/触觉评估方面，外科医生之间没有分歧。（摘要截选至250字）
