Odgers C J, Vaccaro A R, Pollack M E, Cotler J M
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
J Spinal Disord. 1996 Aug;9(4):334-8.
To determine the accuracy of pedicle screw placement with the assistance of lateral plain radiography, a prospective study was performed between June 1991 and March 1994 on patients who had undergone pedicle screw fixation of their thoracolumbar spine for degenerative and traumatic conditions. Sixty-five of 72 patients had the appropriate imaging studies, including an intraoperative lateral plain radiograph and a post-operative computed tomography scan to evaluate pedicle screw placement. A total of 238 screws were inserted from the T11 to L5 vertebral levels. Twenty-four screws penetrated the pedicle wall (18 medial and 6 lateral) and two screws penetrated the anterior vertebral body cortex, for an overall 89.1% success rate. Only two patients had neurologic complications consistent with canal intrusion of a pedicle screw, corresponding to a 0.84% neurologic complication rate. Imaging techniques such as fluoroscopy and anteroposterior plain radiographs, which may increase the incidence of infection from prolonged operative time, are unnecessary in uncomplicated cases. Pedicle screw insertion in the thoracolumbar spine with the use of lateral plain radiography alone is safe and effective, and it minimizes operative time and expense.
为确定在侧位X线平片辅助下椎弓根螺钉置入的准确性，于1991年6月至1994年3月对因退行性和创伤性疾病接受胸腰椎椎弓根螺钉固定的患者进行了一项前瞻性研究。72例患者中有65例进行了适当的影像学检查，包括术中侧位X线平片和术后计算机断层扫描以评估椎弓根螺钉的置入情况。共从T11至L5椎体节段置入238枚螺钉。24枚螺钉穿破椎弓根壁（18枚内侧穿破和6枚外侧穿破），2枚螺钉穿破椎体前皮质，总体成功率为89.1%。只有2例患者出现与椎弓根螺钉侵入椎管相符的神经并发症，神经并发症发生率为0.84%。在无并发症的病例中，诸如透视和前后位X线平片等可能因手术时间延长而增加感染发生率的影像学技术并无必要。仅使用侧位X线平片在胸腰椎置入椎弓根螺钉是安全有效的，且可将手术时间和费用降至最低。
