Aigner R, Bichlmaier C, Oberkircher L, Knauf T, König A, Lechler P, Ruchholtz S, Frink M
Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany.
Department of Diagnostic & Interventional Radiology, University Hospital Giessen and Marburg GmbH, Location Marburg, Marburg, Germany.
BMC Musculoskelet Disord. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y.
While several studies report on accuracy rates of pedicle screws, risk factors associated with inaccurate pedicle screw positioning in patients with thoracolumbar fractures are reported rarely. CT scan as a routine postoperative control is advocated by various authors, however its necessity remains unclear.
Two hundred forty-five patients were included in this retrospective study. Percutaneous dorsal instrumentation was most commonly performed (n = 201). Classification of Zdichavsky et al. and Rao et al. were used to classify screw misplacement and anterior perforation was further evaluated according to the extent of perforation (< 2 mm; > 2 mm). Multivariate analysis was performed to identify risk factors for misplacement of screws.
One thousand sixty-eight pedicle screws were inserted in 245 patients. Misplacement was found in 51 screws (4.8%) in 42 patients (17.1%) according to the classification of Zdichavsky et al. and in 75 screws (7.0%) in 64 patients (26.1%) according to the classification of Rao et al.. An anterior perforation of the vertebral cortex was found in 56 screws (5.2%). Multivariate analysis showed fracture location in the upper thoracic (p = 0.048) and lumbar spine (p = 0.013) to be the only independent predictors for screw misplacement. In addition a significant correlation between pedicle diameter and the occurrence of screw malposition was found (p = 0.003). No consequences were drawn from postoperative routine CT in asymptomatic patients.
An overall low rate of screw misplacement was found with fracture location in the upper thoracic and lumbar spine being the only factors independently associated with the risk of screw misplacement. No consequences were drawn from postoperative routine CT in asymptomatic patients. Therefore its use has to be discussed critically.
虽然有多项研究报告了椎弓根螺钉的准确率，但关于胸腰椎骨折患者椎弓根螺钉定位不准确的相关危险因素的报道却很少。各种作者都主张将CT扫描作为术后常规检查手段，然而其必要性仍不明确。
本回顾性研究纳入了245例患者。最常采用的是经皮后路内固定术（n = 201）。采用兹迪哈夫斯基等人和拉奥等人的分类方法对螺钉误置进行分类，并根据穿孔程度（<2毫米；>2毫米）进一步评估椎体皮质的前方穿孔情况。进行多变量分析以确定螺钉误置的危险因素。
245例患者共植入1068枚椎弓根螺钉。根据兹迪哈夫斯基等人的分类，42例患者（17.1%）的51枚螺钉（4.8%）存在误置；根据拉奥等人的分类，64例患者（26.1%）的75枚螺钉（7.0%）存在误置。56枚螺钉（5.2%）发现有椎体皮质前方穿孔。多变量分析显示，上胸椎（p = 0.048）和腰椎（p = 0.013）的骨折部位是螺钉误置的唯一独立预测因素。此外，还发现椎弓根直径与螺钉位置不当的发生率之间存在显著相关性（p = 群体 003）。无症状患者术后常规CT检查未发现不良后果。
发现螺钉误置的总体发生率较低，上胸椎和腰椎的骨折部位是与螺钉误置风险独立相关的唯一因素。无症状患者术后常规CT检查未发现不良后果。因此，必须审慎讨论其使用情况。
