Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique
Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique
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DOI：
10.1007/s00264-008-0535-x
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发表时间：
2009-04-01
影响因子：
2.7
通讯作者：
Yang, Jae-Hyuk
中科院分区：
文献类型：
--
作者：
Modi, Hitesh;Suh, Seung Woo;Yang, Jae-Hyuk
之前，我们通过徒手技术在尸体上描述了胸椎理想的椎弓根进入点（IPEP），位于外侧三分之一和内侧三分之二交界处的上关节面底部。在这里，我们测量了 43 名脊柱侧弯患者术后计算机断层扫描 (CT) 胸椎椎弓根螺钉置入的准确性（Chung 等人，Int Orthop 2008），这些患者采用相同的进入点进行徒手技术手术。在 854 个插入的螺钉中，有 268 个（31.3%）发生移位； 88 个 (10.3%) 和 180 个 (21.0%) 螺钉分别向内侧和外侧移位。安全区方面，有795颗螺丝在安全区内，准确率达93%； 448 颗和 406 颗胸椎螺钉插入青少年特发性脊柱侧弯和神经肌肉性脊柱侧弯的准确率分别为 89.9% 和 94%（p = 0.6475）。上、中、下胸椎椎弓根螺钉置入准确率分别为 94.2%、91.6% 和 93.7%（p = 0.2411）。结果表明，外科医生在胸椎椎弓根螺钉植入过程中应考虑 IPEP。
Previously, we described the ideal pedicle entry point (IPEP) for the thoracic spine at the base of the superior facet at the junction of the lateral one third and medial two thirds with the freehand technique on cadavers. Here we measured the accuracy of thoracic pedicle screw placement (Chung et al. Int Orthop 2008) on post-operative computed tomography (CT) scans in 43 scoliosis patients who underwent operation with the freehand technique taking the same entry point. Of the 854 inserted screws, 268 (31.3%) were displaced; 88 (10.3%) and 180 (21.0%) screws were displaced medially and laterally, respectively. With regard to the safe zone, 795 screws were within the safe zone representing an accuracy rate of 93%; 448 and 406 thoracic screws inserted in adolescent idiopathic and neuromuscular scoliosis showed an accuracy of 89.9 and 94%, respectively (p = 0.6475). The accuracy rate of screws inserted in the upper, middle and lower thoracic pedicles were 94.2, 91.6 and 93.7%, respectively (p = 0.2411). The results indicate that IPEP should be considered by surgeons during thoracic pedicle screw instrumentation.