Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Ninth Team, Basic Medical College, Naval Medical University, Shanghai, China.
Orthop Surg. 2021 Feb;13(1):35-44. doi: 10.1111/os.12809. Epub 2020 Dec 6.
To propose a novel technique of free-hand pedicle screw placement in cervicothoracic spine (snake-eye method) and evaluate the preliminary effects and safety in clinical practice.
This is a retrospective study and we defined the period of this study as from December 2017 to April 2019 in our institution. Forty patients were included in this study who underwent cervicothoracic internal fixation in our hospital, and all patients undergoing implantation of 200 pedicle screws were divided into two groups. Twenty-two patients (108 screws) had screw placement using traditional method, while 18 patients (92 screws) had screw placement using snake-eye method. To reduce the possible selection bias, the patients we recruited in this study was originally performed on by one radiological doctor who was blind to the objective of this study. Patient demographics, including patient age, sex, obesity, smoking, and hypertension, were evaluated to figure out baseline differences between groups. Medical information was recorded including time, accuracy, and immediate (within 30 days after surgery) postoperative complications of pedicle screw placement (including pulmonary embolism or other thromboembolic events, surgical site infection, neurovascular injury, and mortality).
There were 24 males and 16 females, with an average age of 52.2 years (range, 24-77). Finally, a total of 200 screws were successfully inserted in these patients, including fifteen patients with four pedicle screws, four patients with six screws, three patients with eight screws in traditional method group, and 12 patients with four pedicle screws, two patients with six screws, four patients with eight screws in snake-eye method group. Patient demographic and comparison of two surgery methods are shown in Tables 1 and 2. The data baselines of the two groups were comparable because no impact of the two groups on population characteristics was demonstrated in the presented experiment. Also, we noticed that time and accuracy of the two groups were different with statistical significance at the level of P = 0.05. We observed that immediate (within 30 days after surgery) postoperative complications, including pulmonary embolism (PE), surgical site infection (SSI), neurovascular injury (NI), and mortality, in the two groups did not differ.
This study highlights a safe and effective technique for pedicle screw placement in cervicothoracic spine named snake-eye method, and this technique may be particularly useful in emergency conditions with limited resources.
提出一种颈椎胸椎后路徒手置钉的新方法（蛇眼法），并评估其在临床实践中的初步效果和安全性。
本研究为回顾性研究，定义为我院 2017 年 12 月至 2019 年 4 月期间。本研究共纳入 40 例在我院行颈椎胸椎内固定的患者，所有患者共植入 200 枚椎弓根螺钉，分为两组。22 例（108 枚螺钉）采用传统方法置钉，18 例（92 枚螺钉）采用蛇眼法置钉。为了减少可能的选择偏倚，本研究招募的患者由一位对本研究目的盲法的放射科医生进行操作。评估患者的一般资料，包括患者年龄、性别、肥胖、吸烟和高血压，以找出组间的基线差异。记录置钉的手术时间、准确性和术后 30 天内（包括肺栓塞或其他血栓栓塞事件、手术部位感染、神经血管损伤和死亡率）的即刻并发症等医疗信息。
男性 24 例，女性 16 例，平均年龄 52.2 岁（24-77 岁）。最终，共成功置入 200 枚螺钉，其中传统方法组 15 例 4 枚螺钉，4 例 6 枚螺钉，3 例 8 枚螺钉，蛇眼法组 12 例 4 枚螺钉，2 例 6 枚螺钉，4 例 8 枚螺钉。患者的一般资料和两种手术方法的比较见表 1 和表 2。两组患者的人口统计学数据基线相似，因为在本实验中，两组对人群特征没有影响。此外，我们注意到，两组的时间和准确性存在统计学差异（P = 0.05）。两组术后即刻（术后 30 天内）并发症，包括肺栓塞（PE）、手术部位感染（SSI）、神经血管损伤（NI）和死亡率，无差异。
本研究提出了一种颈椎胸椎后路徒手置钉的安全有效的方法（蛇眼法），该方法在资源有限的紧急情况下可能特别有用。
