Comparison of open versus percutaneous pedicle screw insertion in a sheep model
Comparison of open versus percutaneous pedicle screw insertion in a sheep model
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DOI：
10.1007/s00586-008-0652-7
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发表时间：
2008-06-01
影响因子：
2.8
通讯作者：
Briem, D.
中科院分区：
文献类型：
--
作者：
Lehmann, W.;Ushmaev, A.;Briem, D.
微创手术在创伤性脊柱骨折的治疗中越来越重要。此外，一些临床研究，关于可能对脊柱周围组织造成较低损伤的客观数据仍然缺失。在这里，我们报告了一个绵羊模型，我们比较了经皮与开放的方法，背部器械与椎弓根螺钉的脊柱。12只成年绵羊在L4-L 6节段接受双侧椎弓根螺钉固定。将48枚椎弓根螺钉双侧插入椎弓根，并使用开放式背侧标准或经皮入路与棒连接。对手术时间、血流量、室间压、辐射时间、失血量、实验室检查结果和肌电图进行了评价，以客观评价经皮手术技术的可能优势。经皮组的失血量和作为肌肉损伤标志物的CK-MM分布显著较低。然而，经皮组的辐射时间明显更长。其他参数如室压、血流量以及在不同时间点的EMG测量没有显示出显著差异。根据我们在本研究中发现的结果，经皮螺钉插入可以带来中等优势，但应该注意的是，无法检测到肌肉的基本功能缺陷。
Minimally invasive surgery has become more and more important for the treatment of traumatic spine fractures. Besides, some clinical studies, objective data regarding the possible lower damage to the surrounding tissue of the spine is still missing. Here we report a sheep model where we compared a percutaneous versus an open approach for dorsal instrumentation with pedicle screws to the spine. Twelve skeletally mature sheep underwent bilateral pedicle screw fixation at the L4-L6 level. Forty-eight pedicle screws were bilaterally inserted into the pedicles and connected with rods using either an open dorsal standard or a percutaneous approach. Operation time, blood flow, compartment pressure, radiation time, loss of blood, laboratory findings and EMG were evaluated to objectify possible advantages for the percutaneous operation technique. Loss of blood and the distribution of CK-MM as a marker for muscle damage were significantly lower in the percutaneous group. However, radiation time was significantly longer in the percutaneous group. Other parameters like compartment pressure, blood flow and also measurement of the EMG at different time points did not reveal significant differences. Based on the results we found in the present study, percutaneous screw insertion can bring moderate advantages but it should be noted that essential functional deficits to the muscle could not be detected.