可视化胸腰椎椎弓根钉道探子的设计及临床初步应用

Design and clinical application of visual pedicle probe for inspecting the walls of thoracolumbar pedicle screw trajectory

目的探讨可视化胸腰椎椎弓根钉道探子的设计并评价其临床应用结果。方法将脊柱内镜结构简化和外径缩小化,设计成可视化椎弓根探子(VPP)。11例需行胸腰椎椎弓根镙钉内固定患者,术中椎弓根钉道准备好后,使用VPP判断钉道四壁是否完整。术后复查CT评价椎弓根镙钉位置,并将镙钉准确性分为4级,计算镙钉位置优良率。结果11例患者术中VPP均显示钉道四壁及前方均为骨质,提示钉道位置良好。置入椎弓根节段及数量:T_(10)4枚,T_(11)6枚,T_(12)8枚,L_(1)9枚,L_(2)5枚,L_(3)4枚,L_(4)8枚,L_(5)6枚。术后复查CT提示所有镙钉位置良好,准确性分级均为0级,镙钉位置优良率为100%。结论VPP探查胸腰椎椎弓根钉道安全、可靠,但该技术仍需进一步改进,可作为现有判断胸腰椎椎弓根钉道方法中的一种重要补充手段。

Objective To investigate the design of visual pedicle probe and evaluate the feasibility for applying it to inspect the walls of thoracolumbar pedicle screw trajectory.Methods A visual pedicle probe(VPP)was designed to simplify the structure and reduce the diameter of the spinal endoscope.For 11 patients who needed thoracolumbar pedicle screw fixation,the visual pedicle probe was inserted into pedicle to inspect the integrity of around walls of pedicle when the pedicle screw trajectory was preparation.The accuracy of pedicle screw was evaluated by CT imaging with classification four grades after operation,and the excellent-good rate of the screw position was calculated.During the operation,VPP showed that the four walls and the front of the screw trajectory were bony,indicating that the screw trajectory was in good position.The segment and number of pedicle were as follows:4 pieces for T_(10),6 pieces for T_(11),8 pieces for T_(12),9 pieces for L_(1),5 pieces for L_(2),4 pieces for L_(3),8 pieces for L_(4),and 6 pieces for L_(5).The postoperative CT examination showed that all the screws were in good position,the accuracy grade was 0,and the excellent-good rate of the screw positions was 100%.Conclusion Applying the VPP to inspect the walls integrity of pedicle screw trajectory during intraoperative was safe,effective and handy,but it still needs further improvement.The technology could be seen as an important supplement for current method of probing the walls of pedicle screw trajectory.