统一解剖标志徒手胸椎椎弓根置钉技术的初步应用

The preliminary application of freehand placing thoracic pedicle screw technique with uniform anatomical marks

目的通过与传统的胸椎徒手置钉方法比较,评价统一解剖标志徒手胸椎椎弓根置钉技术的准确性与安全性。方法 2014年12月至2015年2月在我科接受胸椎椎弓根螺钉固定术的25例患者,其胸椎椎弓根螺钉的置入右侧采用Fennell提出的统一解剖标志新型置钉法,左侧采用Kim提出的传统置钉法。术后根据Heary分级,对比评价左右侧椎弓根螺钉钉道位置的准确性及安全性。结果 25例患者共有133枚胸椎椎弓根螺钉植入,其中Fennell新型置钉法徒手置钉67枚,置钉准确率为89.55%(Heary分级Ⅰ级),安全率97.01%(Heary分级Ⅱ级以上),共有7枚(10.45%)螺钉出现钉道位置不良(Heary分级Ⅰ级以下),平均置钉时间5.75 min;传统置钉法徒手置钉66枚,置钉准确率为75.76%,安全率为89.39%,16枚(24.24%)螺钉出现钉道位置不良,平均置钉时间8.95 min。两中方法在置钉准确性上差异具有统计学意义(P<0.05),在置钉钉道安全性方面差异无统计学意义(P>0.1),在操作时间上差异具有统计学意义(P<0.05)。结论与传统置钉方法相比,两者安全性方面并无明显差异,但统一解剖标志徒手胸椎椎弓根置钉技术,钉道位置更准确,且操作更简单,更易接纳、学习及交流推广。

Objective To evaluate the accuracy and safety of freehand placing thoracic pedicle screw technique with uniform anatomical marks, as compared with the conventional freehand technique. Methods From December 2014 to February 2015, a contrast study was performed on 25 patients needed posterior surgery with pedicle screw in our department. The right side thoracic pedicle screws were implanted with uniform anatomical marks put forwarded by Fennell, while the left side ones were done with traditional method described by Kim. The accuracy and safety of the pedicle screw placements was evaluated according to Heary classification after operation. And the time of implanting screws on each side was compared. Results A total of 133 thoracic pedicle screws were assessed. There were 67 screws implanted by the new method. The accuracy of this technology was 89.55% （Heary classⅠ） and the security was 97.01% （Heary classⅡabove）. 7 （10.45%） screws were considered in a negative location （below Heary classⅠ）.The average time of placing pedicle each screw was 5.75 min. while, there were 66 pedicle screws implanted by traditional method. The accuracy of this technology was 75.76% and the security was 89.39%. A total of 16 screws （24.24%） developed bad location. The average time of placing each pedicle screw was 8.95 min. A significant difference in the accuracy of pedicle screw placement was observed between the 2 methods（P〈0.05）,But on the security of implanting screws has no statistically significant （P〉 0.1）. In addition, there was significant difference in the implanting time between the 2 methods （P〈0.05）. Conclusion Free hand placing thoracic pedicle screw technique with uniform anatomical marks is more accurate for screw location, more simple for operation, more easy for acceptance, learning and communication.