“球尖”与“徒手”技术在胸椎椎弓根钉置入的比较研究

Comparative research of ‘ball tip’ technique and ‘freehand’ technique for thoracic pedicle screw placement

摘要:

目的：探讨采用“球尖”技术置入胸椎椎弓根螺钉（Thoracic pedicle screw，TPS）的准确性及安全性。方法：2010年1月至2011年1月，对79例胸椎病变患者实施TPS治疗；其中采用“球尖”技术治疗37例（Ⅰ组），采用“徒手”技术治疗42例（Ⅱ组）。记录螺钉置入操作中和术后并发症，术中3D-C臂断层扫描或术后行CT断层扫描检查判断螺钉穿透骨皮质的数目和距离，以评价“球尖”技术的准确性和安全性。结果：两组共置入ＴＰＳ 478枚，其中Ⅰ组有10枚（4.45%）发生穿孔，Ⅱ组有67枚（26.48%）发生穿孔（P < 0.001）；Ⅰ组8枚穿破皮质的距离 < 2 mm，2枚穿破皮质2～4 mm；Ⅱ组的48枚穿破椎弓根皮质 < 2 mm，18枚穿破皮质2～4 mm，1枚穿破皮质 > 4 mm。Ⅱ组1例患者术后出现单节段性背部感觉麻木，予以营养神经治疗1周后恢复，余患者未见血管、神经和内脏损伤等并发症。结论：“球尖”技术在ＴＰＳ置入中精确性及安全性较“徒手”技术高。

Abstract:

Objective：To evaluate the efficacy and safety of the ‘ball tip’ technique in placing thoracic pedicle screw（TPS） as com－pared with the conventional ‘freehand’ technique. Methods：Totally 79 patients scheduled for ＴＰＳ placement from January 2010 to Jan－uary 2011 were divided into group Ⅰ（37 patients，with ball tip technique） and group Ⅱ（42 patients，with conventional free hand tech－nique） randomly. All patients in both groups were scanned by intraoperative 3D-C arm or postoperative CT to measure the accuracy and safety of TPS placement and the pedicle perfo－ration. Results：Totally 478 screws were placed and perforation was occurred in 10 screws（4.45%） in groupⅠand 67 screws（26.48%） in groupⅡ（P <0.001）. In groupⅠand groupⅡ，the respective numbers of TPS with pedicle perforation ≤ 2 mm were 8 and 48（P <0.001），with pedicle perforation between 2-4 mm were 2 and 18（P =0.001） and with pedicle perforation > 4 mm were 0 and 1. One case in group Ⅱsuffered segmental back pain after surgery but recovered by using neurotrophy drugs at one week postoperatively. No vascular，internal organ，neurological injuries caused by TPS placement was occurred in the others patients in both groups. Conclu－sion：The ‘ball tip’ technique shows high accuracy and safety in TPS placement as compared with the conventional ‘freehand’ tech－nique.