不同人群腰椎椎弓根直径及椎弓根螺钉估计长度的人口统计学分析
Demographic Analysis of Pedicle Diameter, and Estimated Pedicle Screw Length of the Lumbar Spine in a Diverse Population.
作者信息
Petrone Brandon, Albano Joseph, Stockton Robert, Atlas Aaron M, Aronica Courtney, Grewal Kanwarpaul
机构信息
Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York.
出版信息
Int J Spine Surg. 2021 Apr;15(2):259-265. doi: 10.14444/8035. Epub 2021 Apr 1.
BACKGROUND
Recent literature confirms the importance of understanding the variability in pedicle morphology among races. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, there is limited data on average pedicle diameters (PDs) or estimated pedicle screw lengths (EPSLs) between diverse racial populations. We sought to determine the differences in PD and EPSL in the lumbar spine between various races: "Asian," "Black," "White," and "Hispanic" to aid in perioperative planning during instrumented spinal fusion.
METHODS
Axial cuts of 404 patients were inspected to obtain their transverse outer cortical PD as measured through the isthmus, and EPSL by measuring the posterior entry point at the longest distance, which perpendicularly transected the measured isthmic diameter, to the anterior vertebral cortex from L1 to L5. We examined the average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis.
RESULTS
In this retrospective chart review the races were found to be significantly different in PD and EPSL ( < .001). Post hoc analysis using Dunn-Bonferroni correction showed that Asians had significantly smaller PDs than Blacks and Whites ( < .002 and < .014, respectively). The White and Hispanic population had significantly longer EPSLs when compared to Blacks and Asians from L1 to L5 ( < .01).
CONCLUSIONS
This study demonstrates that there are significant differences in pedicle morphology among races that must be taken into consideration when inserting pedicle screws during lumbar spinal fusion. Knowledge of these differences is of the utmost importance in order to limit complications while improving fixation.
LEVEL OF EVIDENCE
CLINICAL RELEVANCE
Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.
背景
近期文献证实了了解不同种族椎弓根形态变异性的重要性。这些研究表明，应对椎弓根进行更详细、可靠的测量。然而，关于不同种族人群的平均椎弓根直径（PDs）或估计的椎弓根螺钉长度（EPSLs）的数据有限。我们试图确定不同种族（“亚洲人”“黑人”“白人”和“西班牙裔”）腰椎的PD和EPSL差异，以辅助脊柱内固定融合手术的围手术期规划。
方法
检查404例患者的轴向切片，以获取通过峡部测量的横向外侧皮质PD，以及通过测量从L1至L5最长距离处的后入点（该点垂直横切测量的峡部直径）到椎体前皮质的EPSL。我们检查了每个种族在每个节段的平均PD和PD范围。为确定其显著性，我们使用了方差混合分析和事后分析。
结果
在这项回顾性图表审查中，发现不同种族在PD和EPSL方面存在显著差异（P <.001）。使用Dunn-Bonferroni校正的事后分析表明，亚洲人的PD明显小于黑人和白人（分别为P <.002和P <.014）。与L1至L5的黑人和亚洲人相比，白人和西班牙裔人群的EPSL明显更长（P <.01）。
结论
本研究表明，不同种族的椎弓根形态存在显著差异，在腰椎融合手术中插入椎弓根螺钉时必须予以考虑。了解这些差异对于限制并发症同时提高固定效果至关重要。
证据级别
3。
临床相关性
不同种族之间椎弓根形态存在差异，了解这些差异对于安全置入椎弓根螺钉很重要。
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