Farber G L, Place H M, Mazur R A, Jones D E, Damiano T R
Orthopedic Service, Fitzsimons Army Medical Center, Aurora, Colorado, USA.
Spine (Phila Pa 1976). 1995 Jul 1;20(13):1494-9. doi: 10.1097/00007632-199507000-00010.
Postoperative radiographs and computed tomography scans were used to evaluate 74 pedicle screws in 16 consecutive patients who underwent lumbar spine fusion with pedicle screw fixation.
To evaluate pedicle screw placement using plain radiographs versus computed tomographic scans.
Plain radiographs are the primary means of assessing pedicle screw placement. Comparison of plain radiographs and computed tomography has not been done.
Screws were graded as IN, OUT, or QUESTIONABLE; the direction of misplacement was noted. All evaluations were performed independently by three observers.
Fewer screws were clearly within the pedicle on computed tomography when compared with plain radiographs. Computed tomography showed 10 times as many screws violating the medial cortex as did radiographs. Interobserver differences were not statistically significant. Intraobserver differences approached statistical significance when the two tests were compared. No recognized neurologic complications resulted from pedicle screw placement.
Plain radiographs alone may not accurately reveal pedicle screw placement. Plain radiographs and thin section computed tomographic scans should be used to evaluate postoperative neurologic deficits in patients undergoing instrumented lumbar spine fusion with pedicle screws.
对16例连续接受腰椎融合椎弓根螺钉固定术的患者的74枚椎弓根螺钉，采用术后X线片和计算机断层扫描进行评估。
比较X线平片与计算机断层扫描在评估椎弓根螺钉置入情况方面的差异。
X线平片是评估椎弓根螺钉置入情况的主要手段。尚未对X线平片与计算机断层扫描进行比较。
将螺钉分为置入良好、穿出或可疑；记录误置方向。所有评估均由三名观察者独立进行。
与X线平片相比，计算机断层扫描显示清晰位于椎弓根内的螺钉较少。计算机断层扫描显示侵犯内侧皮质的螺钉数量是X线片的10倍。观察者间差异无统计学意义。当比较两种检查时，观察者内差异接近统计学意义。椎弓根螺钉置入未导致公认的神经并发症。
仅靠X线平片可能无法准确显示椎弓根螺钉的置入情况。对于接受腰椎融合椎弓根螺钉内固定术的患者，应使用X线平片和薄层计算机断层扫描来评估术后神经功能缺损情况。
