Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
J Clin Neurosci. 2020 Jun;76:214-218. doi: 10.1016/j.jocn.2020.04.013. Epub 2020 Apr 15.
Percutaneous pedicle screws(PPS) have been used for decades. The difficult part of PPS placement is locating the proper entry sites on the facet joints for the Jamshidi needles. The correct positioning is usually ensured by fluoroscopy, which exposes surgeons and patients to extensive radiation exposure.
To describe a novel retractor tube technique used in the placement of PPS, which enables visualization of the anatomy of the facet joints and enables accurate placement of the Jamshidi needles.
A newly designed 15-mm-diameter retractor tube was applied during the placement of Jamshidi needles in 21 operations using PPS to treat thoracolumbar fracture. The anatomy of the entry site could be clearly visualized, and a Kirschner wire was inserted 2 mm into each of the ideal entry sites. When all the Kirschner wires were placed, the annular tubes of the Jamshidi needles were placed along the Kirschner wires into the pedicles. Fluoroscopy was used to confirm the positions of the Jamshidi needles. The rest of the procedure was conducted in the traditional PPS placement technique.
The entrance sites were successfully accessed through the retractor tube, with only one adjustment needed at most. Only one or two fluoroscopy images were taken during the placement of the Kirschner wires, and another image was taken after all the Jamshidi needles were placed. Fluoroscopy confirmed that the positioning of the PPS was good.
A retractor tube accurately exposes the entry points on the facet joints in PPS placement, and is technically easy to use.
经皮椎弓根螺钉（PPS）已经使用了几十年。PPS 放置的难点在于在关节突关节上找到合适的进针点进行 Jamshidi 针穿刺。通常通过透视来确保正确的定位，这会使外科医生和患者暴露在大量的辐射下。
描述一种用于 PPS 放置的新型牵开器管技术，该技术可以使关节突关节的解剖结构可视化，并实现 Jamshidi 针的准确放置。
在使用 PPS 治疗胸腰椎骨折的 21 例手术中，应用一种新设计的 15 毫米直径的牵开器管进行 Jamshidi 针的穿刺。可以清楚地观察到进针点的解剖结构，并将克氏针插入每个理想进针点 2 毫米。当所有的克氏针都放置好后，将 Jamshidi 针的环形管沿着克氏针插入椎弓根。透视确认 Jamshidi 针的位置。其余步骤按照传统的 PPS 放置技术进行。
通过牵开器管成功进入入口部位，最多只需调整一次。在放置克氏针的过程中只需要拍摄一到两张透视图像，在放置完所有的 Jamshidi 针后再拍摄一张图像。透视确认 PPS 的定位良好。
牵开器管可准确暴露 PPS 放置中的关节突关节的进针点，且技术上易于使用。
