Wong Chia-En, Lee Po-Hsuan, Chen Chien-Min, Huang Chi-Chen, Hsu Hao-Hsiang, Chen Liang-Yi, Huang Chih-Yuan, Wang Liang-Chao, Lee Jung-Shun
Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Br J Neurosurg. 2025 Apr;39(2):210-216. doi: 10.1080/02688697.2023.2211174. Epub 2023 May 11.
This study aimed at the evaluation and assessment of a simple method, the transverse process resection (TPR) technique, for freehand thoracic pedicle screw placement and the learning curve for trainee surgeons.
In the TPR technique, the tip of the thoracic transverse process (TP) is removed to create an entry point in the cancellous bone of the TP, and the thoracic pedicle is cannulated from the TP. We retrospectively evaluated the safety and radiographic results of the TPR technique and compared with that of conventional pedicle screws. The training performance of seven neurosurgical residents with TPR techniques were evaluated.
Among 46 patients, a total of 322 thoracic screws were analyzed, including 178 screws placed using the TPR technique and 144 screws using the conventional straight-forward (SF) technique. TPR screws had greater medial angulations in all levels from T2 to T12 compared to SF screws ( < 0.001). The incidence of pedicle breach was lower in the TPR screws compared to SF screws (6.2% vs. 21.5%, p < 0.001), especially for screws placed by residents (6.7% vs. 29.6%, < 0.001). Residents had improved performance following a cadaveric training course on the TPR technique ( = 0.001).
This study demonstrated the safety of the TPR technique for thoracic pedicle screw placement and its short learning curve for trainee surgeons.
本研究旨在评估一种简单的方法——横突切除术（TPR）技术，用于徒手置入胸椎椎弓根螺钉以及实习外科医生的学习曲线。
在TPR技术中，切除胸椎横突（TP）的尖端，在TP的松质骨中创建一个入点，然后从TP向胸椎椎弓根插入套管。我们回顾性评估了TPR技术的安全性和影像学结果，并与传统椎弓根螺钉进行比较。评估了7名神经外科住院医师使用TPR技术的训练表现。
在46例患者中，共分析了322枚胸椎螺钉，其中178枚使用TPR技术置入，144枚使用传统的直接（SF）技术置入。与SF螺钉相比，TPR螺钉在T2至T12的所有节段中具有更大的内侧成角（<0.001）。与SF螺钉相比，TPR螺钉的椎弓根穿破发生率更低（6.2%对21.5%，p<0.001），尤其是住院医师置入的螺钉（6.7%对29.6%，<0.001）。住院医师在接受TPR技术的尸体训练课程后表现有所改善（=0.001）。
本研究证明了TPR技术用于胸椎椎弓根螺钉置入的安全性及其对实习外科医生较短的学习曲线。
