三维CT导航在腰椎再次手术及翻修术中椎弓根螺钉置入的应用研究(附13例报告)

目的探讨三维CT导航在腰椎再次手术及翻修手术椎弓根螺钉置入中的准确性及安全性。方法回顾性研究自2008年9月~2009年9月,收治因腰椎再次手术及翻修需进行椎弓根螺钉系统内固定13例,其中腰椎间盘术后继发椎管狭窄4例,腰椎置钉失败2例,全椎板或半椎板切除术后腰椎不稳4例、椎体滑脱3例。在减压解除神经根压迫同时在三维CT导航引导下行椎弓根螺钉固定矫形。采用术中G型臂X线机正侧位摄片与导航路径进行比较测量以及术后三维影像系统(CT、MRI)评估螺钉位置的准确性,螺钉完全位于椎弓根内为置钉位置准确,记录螺钉平均置入时间。结果共置入62枚螺钉,术中及术后X线片评估椎弓根螺钉置钉准确度为100%,术后三维影像评估螺钉位置准确率为91.8%,螺钉平均置入时间(4.7±0.7)min/枚,未出现螺钉置入相关的近期并发症。结论腰椎再次手术及翻修手术患者术中应用CT三维影像导航辅助行椎弓根螺钉置入,可以有效的提高置钉的精确性以及保证了安全性,降低了脊柱再次手术及翻修手术的风险性,减少放射线的暴露强度。     

个体化导航模板辅助腰椎椎弓根螺钉置钉准确性实验研究

目的:探讨个体化导航模板辅助腰椎椎弓根螺钉置入的准确性.方法:根据10具尸体腰椎(L1～L4)标本术前CT资料,利用逆向工程原理及快速成型技术设计制造出个体化导航模板,在尸体标本上进行个体化导航模板辅助腰椎椎弓根螺钉的置入手术,术后行CT断层扫描评价螺钉在椎弓根及椎体内的位置.结果:共应用40个个体化导航模板,辅助置入腰椎椎弓根螺钉80枚.CT扫描发现所有螺钉进钉点准确,进钉方向适当:全部螺钉均准确置入相应椎弓根及椎体内,无穿破椎弓根皮质及椎体前方的螺钉.结论:个体化导航模板辅助腰椎椎弓根螺钉置钉准确性高,操作简单,为腰椎椎弓根螺钉的准确置入提供了一种新的可供选择的方法.     

三维导航在脊柱畸形或翻修手术患者椎弓根螺钉置入中的应用

目的：探讨三维影像脊柱导航指导脊柱畸形或脊柱翻修手术患者椎弓根螺钉置入的准确性。方法：2003年9月-2007年12月，收治脊柱存在先天畸形或脊柱后柱结构缺损需进行椎弓根螺钉系统内固定的患者58例．其中先天性脊柱侧凸并脊髓畸形31例、全椎板或半椎板切除术后脊柱不稳27例，在减压解除神经压迫同时在三维影像脊柱导航引导下行椎弓根螺钉固定矫形，采用三维影像系统评估螺钉位置的准确性，螺钉完全位于椎弓根内为置钉位置准确；记录螺钉平均置入时间、手术时间、出血量和近期并发症。结果：58例患者共置入426枚螺钉，螺钉位置准确率为96％，螺钉平均置入时间3．90±0．87min／枚，手术时间147±65min，出血量312±185ml，未出现螺钉置入相关的并发症。结论：术中应用三维影像导航对脊柱畸形或脊柱翻修手术患者行椎弓根螺钉置入快速、精确和安全，为高风险的脊柱脊髓畸形及脊柱翻修手术的精确性、安全性提供了保证。     

三维导航技术在微创经椎间孔入路腰椎椎间融合术中的应用

目的 探讨术中三维导航技术在微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中的应用价值.方法 2016年1月—2017年12月采用MIS-TLIF治疗腰椎退行性疾病患者64例,其中32例术中应用三维导航(A组),另32例术中采用传统C形臂X线机透视(B组).记录并比较2组手术时间、术中出血量、术中辐射量、置钉准确率及每枚螺钉置入时间,采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及日本骨科学会(JOA)评分评价临床疗效,记录并发症发生情况.结果 所有手术顺利完成.所有患者随访24～48个月,平均29.5个月.A组手术时间、术中出血量、置钉准确率及每枚螺钉置入时间优于B组,而术中辐射量则高于B组,差异均有统计学意义(P<0.05).2组术后VAS评分、ODI及JOA评分均较术前显著改善,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05).所有患者术中、术后均无明显并发症发生.结论 MIS-TLIF术中应用三维导航技术可提高置钉准确率,缩短手术时间,提高手术的便利性和安全性.     

脊柱导航三维影像系统在椎弓根螺钉固定术中的应用

目的：探讨脊柱导航三维影像系统在椎弓根螺钉固定术中的应用效果。方法：49例腰椎间盘突出症伴椎管狭窄症、多节段腰椎管狭窄症伴不稳或退行性侧弯、腰椎滑脱、腰椎爆裂骨折患者分别采用脊柱导航一术中三维影像系统(A组)和传统X线透视法(B组)行椎弓根螺钉固定术，并采用术中三维影像系统评估螺钉位置的精确性；分析比较两组患者螺钉位置、平均螺钉植入时间、手术时间、出血量和近期并发症。结果：A组螺钉位置优良率明显高于B组，平均螺钉植入时间、手术时间、出血量低于B组。A组未发现手术近期并发症。结论：脊柱导航一术中三维影像系统使椎弓根螺钉固定手术更精确、简便、快速和安全，减少术后并发症的发生，为脊柱手术微创化、精确化、安全化发展提供了可靠保证。     

3D打印辅助椎弓钉置入融合术治疗腰椎滑脱

[目的]探讨3D打印辅助椎弓根螺钉置入融合术治疗腰椎滑脱的临床效果。[方法] 2015年10月～2016年10月69例单节段椎体滑脱患者纳入本研究。随机分为两组, 3D组36例患者采用3D打印导板辅助椎弓根置入术,传统组33例患者采用传统置钉法置入椎弓根。术后对比分析两组术中出血量、透视次数、单个椎弓根螺钉术中置入时间、准确率、术后即刻及术后12个月时滑脱的腰椎节段矢状曲度恢复率。[结果]两组患者均顺利完成手术,两组患者术中均未出现神经和血管损伤等严重并发症。3D组术中出血量、透视次数及单个螺钉置入时间均显著低于传统组学(P0.05)。所有患者随访12～31个月,平均(19.34±4.89)个月。末次随访时,两组VAS和ODI评分较术前显著减少(P0.05),而JOA评分显著增加(P0.05)。相应时间点,两组间VAS、ODI和JOA评分的差异均无统计学意义(P0.05)。影像方面:术后3D组35例(97.22%),传统组29例(87.87%)螺钉完全置于椎弓根内,两组间差异有统计学意义(P0.05)。3D组术后即刻及术后12个月腰椎固定节段矢状曲度均优于传统组,差异有统计学意义(P0.05)。[结论] 3D打印辅助椎弓根螺钉置入能够有效缩短术中操作时间,并取得更好的临床疗效。     

三维影像脊柱导航引导后路内固定及融合治疗退行性腰椎滑脱

目的 探讨三维影像脊柱导航引导下后路内固定及融合治疗退行性腰椎滑脱的临床疗效.方法 对38例退行性腰椎滑脱进行影像导航引导下后路经椎弓根螺钉内固定、减压及后外侧植骨融合术.结果 临床症状明显改善,融合率达92.1%,术后JOA评分明显高于术前(P＜0.05),VAS评分明显低于术前(P＜0.05).结论 术中三维影像导航引导下治疗退行性腰椎滑脱,准确定位椎弓根螺钉置入点,减少并发症,提高后外侧植骨融合率,可获得满意的疗效.     

C型臂机透视与导航下经皮空心螺钉内固定治疗骨盆骨折的比较研究

目的比较C型臂机透视下与导航下经皮空心螺钉内固定治疗骨盆骨折的临床效果，分析两种技术的特点。方法2005年1月．2006年2月，前瞻性研究采用微创内固定技术治疗23例骨盆骨折患者，其中男16例，女7例；平均年龄36．5岁。随机分为两组：A组采用X线透视下螺钉置入技术，共11例；B组应用计算机辅助导航下螺钉置入技术，共12例。比较两组患者在平均X线暴露时间、每枚螺钉置入时间、手术时间、骨折愈合时间、复位满意率及术后功能优良率等方面的结果。结果平均手术时间为83．4min，其中B组手术时间平均为75．3min，A组为91．6min。与A组比较，B组平均X线暴露时间、每枚螺钉置入时间、手术时间均较少，差异有统计学意义（P〈0．05）；而在平均骨折愈合时间、复位满意率及术后功能优良率方面，两组差异无统计学意义（P〉0．05）。术中出血量为10，30mL。术后经6，18个月（平均13．5个月）随访，无骨折延迟愈合或畸形愈合。结论经皮微创空心螺钉内固定技术手术创伤小、术后并发症少、骨折愈合率高、固定可靠、患者功能恢复满意，是治疗骨盆骨折的有效手段。应用计算机辅助导航技术可减少X线透视时间，缩短手术时间，使手术更加精确、安全。     

机器人导航定位系统辅助经皮骶髂螺钉治疗骨盆后环不稳定型损伤的临床研究

背景:机器人导航定位系统GD-2000是国内自主研发的基于术中X线透视影像的双平面骨科机器人系统,可用于辅助完成经皮股骨颈空心螺钉和骶髂螺钉置入的内固定术。目的:探讨机器人导航定位系统辅助完成经皮骶髂螺钉内固定术的安全性及有效性。方法:回顾性分析2016年6月至2018年8月收治的21例骨盆骨折后环不稳定型损伤患者,均采用机器人导航定位系统辅助经皮骶髂螺钉内固定术,男16例,女5例;年龄27~52岁,平均(38.2±6.9)岁。按Tile分型,B1型7例,B2型6例,B3型5例,C1型3例。记录每枚螺钉的置入时间、X线透视时间、钻孔次数,术后CT检查评价螺钉置入位置,统计术后并发症发生情况,术后6个月随访进行Majeed功能评分。结果:21例患者共置入27枚螺钉,全部患者均一次钻孔完成螺钉置入,每枚螺钉置入时间为18~56 min,平均(38.6±9.5)min;X线透视时间为12~21 s,平均(16.5±3.5)s。所有螺钉位置满意,无螺钉切出骨皮质、误入骶孔或骶管,未出现医源性血管神经损伤及切口感染。术后6个月随访的Majeed评分,优14例,良6例,可1例,优良率为95.2%。结论:应用机器人导航定位系统辅助经皮骶髂螺钉内固定术具有定位准确、稳定性好、手术时间短、创伤小等优点,降低了手术风险,减少医护人员和患者的放射性损害,是一种治疗骨盆后环损伤安全而有效的技术选择。     

机器人辅助与徒手置钉在腰椎翻修术早期结果比较

[目的]比较Renaissance机器人系统辅助椎弓根螺钉置入与徒手椎弓根螺钉置入在腰椎翻修手术中的安全性及准确性。[方法]回顾性分析2018年1月~2018年12月在本院行腰椎后路翻修手术的病例69例,其中使用Renaissance机器人系统辅助椎弓根螺钉置入共31例,使用传统徒手椎弓根螺钉置入38例。记录临床资料,并根据术后CT对螺钉精度进行Gertzbein Robbins分级,比较螺钉置入准确性。[结果]两组患者手术时间、术后出血量及手术相关并发症等差异无统计学意义(P0.05)。机器人组术中出血量、术中透视次数显著少于徒手组(P0.05)。机器人辅助组共置入螺钉152枚,术后CT评估显示:A级置钉137枚,B级置钉11枚,C级置钉4枚,没有D、E级置钉,置钉准确率97.37%。徒手组共置入螺钉194枚,术后CT评估显示:A级置钉129枚,B级置钉48枚,C级置钉15枚,D级置钉2枚,没有发现E级置钉,置钉准确率91.24%。在螺钉精度分级及螺钉准确性方面,机器人组优于徒手组,差异具有统计学意义(P0.05)。[结论]与徒手置钉技术相比,Renaissance机器人系统辅助椎弓根螺钉置入在腰椎翻修手术中具有置钉精度高、且术中出血及术中透视次数少的优势。     

Accuracy of single-time, multilevel registration in image-guided spinal surgery.

BACKGROUND CONTEXT: Computerized frameless stereotactic image-guidance has been used in recent years to improve the accuracy and safety of pedicle screw placement during spine surgery. Because the possibility of intervertebral motion exists, and because the patient is usually in a different position when preoperative imaging is performed compared with the operative position, it has been suggested that the imaging model of the complete lumbar spine and the surgically exposed lumbar spine may be significantly discordant. Consequently, current protocols suggest registering each spinal level (single-level registration) separately before pedicle screw placement at that level, a time-consuming process. PURPOSE: To assess the accuracy of single-time multilevel registration for multilevel pedicle screw placement during image-guided, computer-assisted spine surgery, in the setting of degenerative disorders of the lumbar spine. STUDY DESIGN/SETTING: This is a prospective clinical and radiological study of 45 patients with degenerative disorders of the lumbar spine who underwent instrumented fusion with the use of single-time multilevel registration computer-assisted, image-guided tomography. The accuracy of the pedicle screws placement was confirmed on the basis of a protocol that included intraoperative spontaneous electromyographic (EMG) recordings, direct pedicle visualization, and computer tomography (CT) scans when clinically indicated during the follow-up period. PATIENT SAMPLE: Forty-five consecutive patients who fulfilled the criteria of computer-assisted, image-guided tomography pedicle screw placement for degenerative lumbar spine disease without overt instability. OUTCOME MEASURES: The principal outcome measure was the accuracy of pedicle screw placement with single-time multilevel registration for multilevel pedicle screw placement during image-guided, computer-assisted spine surgery; postoperative CT performed for clinical indications during the follow-up course was used for the assessment of pedicle screw placement. METHODS: Patients were assessed clinically before and after the operation. Data from 45 consecutive cases of image-guided, computer-assisted lumbar spinal fusion were statistically analyzed to determine the relationship between the number of levels registered during single-time registry and the mean registration error (MRE). Intraoperative spontaneous EMG, direct visualization, and postoperative CT scans were used to assess the accuracy of pedicle screw insertion. RESULTS: None of the patients involved in this study experienced clinical sequelae of improper pedicle screw placement. MREs after surface mapping and after point merge were small (less than 1.00 mm and less than 3.00 mm, respectively). During the intraoperative assessment of the pedicle screws placement, no significant spontaneous EMG activity was recorded and the pedicular walls were found intact in direct visualization. The postoperative CT scans showed in 10 patients accurate placement in 55 of the 57 pedicle screws with expansion of the medial wall in two screws. CONCLUSIONS: Single-time, multilevel registration may decrease operative time relative to repeated, single-level registrations, without compromising the increased accuracy of pedicle screw placement afforded by this technique in the setting of degenerative disorders of the lumbar spine. Despite the advantages in computer-guided image surgery, cautious application in the individual patient is recommended until more comprehensive data can be gathered in specific degenerative pathology with overt instability; thus the knowledge of the anatomy remains crucial.     

Computernavigierte Implantation transpedikulärer Schrauben in die Lendenwirbelsäule

OBJECTIVE: Decrease of surgical risks in transpedicular, lumbar spondylodesis by insertion of screws into the pedicle under continuous visual control of the screw channel in the sagittal, axial, and orthogonal planes in relation to the direction of screw insertion. INDICATIONS: All indications of a transpedicular lumbar spondylodesis performed for intervertebral instability, spinal stenosis, or displacement of vertebrae secondary to degenerative diseases. CONTRAINDICATIONS: Previous surgery that does not permit the obligatory intraoperative matching. Usual contraindications for lumbar spondylodesis. Spondylolyses, as they rarely allow a satisfactory result of matching due to the mobility in the vertebral segment. SURGICAL TECHNIQUE: Preoperative multi-slice computed tomography (CT). Intraoperative matching of real and virtual views. On the monitor the instruments are controlled visually in their relation to the lumbar spine in almost real time. Opening of pedicles and insertion of screws. Only thereafter, treatment of the pathologic conditions either by decompression or realignment of the spine. RESULTS: Between July 2000 and February 2002 this system was selected for 109 patients. No complications were observed and no revision became necessary. The screw length varied between 35 and 50 mm; the length of the screws does not affect the procedure. Intra- and postoperative radiographs (anteroposterior and lateral) were done in every patient. The first 48 patients underwent CT control that confirmed the optimal intrapedicular and intravertebral screw position. Thereafter, these controls were omitted for cost-saving.     

新型可膨胀椎弓根螺钉在骨质疏松性腰椎融合与固定手术中的初步应用

目的 评价新型可膨胀椎弓根螺钉(Thunder钉)在骨质疏松性腰椎椎体中固定的可靠性及其临床疗效.方法 随访2006年8月至2007年12月,应用Thunder钉治疗合并骨质疏松症的各种腰椎疾患42例(236枚螺钉),其中腰椎退行性疾病24例,腰椎结核二期后路融合手术8例,腰椎骨质疏松性压缩骨折6例,腰椎翻修手术4例.所有病例术前均行骨密度检查,患者腰椎骨密度平均下降2.6个标准差.术后处理与其他腰椎内固定术后患者相同.术后1周、3个月、半年、1年及2年随访患者,摄X线片并进行CT扫描三维重建,了解椎弓根螺钉稳定性及脊柱融合情况.结果42例患者均获平均16(12～24)个月的随访.术后3、6、12及24个月的影像学检查显示,所有Thunder钉位置良好,无螺钉松动、断裂迹象,评分平均值分别为3.0、3.0、2.9和2.9.脊柱骨融合于术后随时间延长趋于完善,骨融合评分平均值分别为2.3、2.5、3.0、3.0.所有患者临床症状缓解,疗效满意.结论 Thunder钉具有良好的钉-骨界面结合,能够提高螺钉在骨质疏松椎体中的固定强度,为脊柱融合提供良好的基础,临床疗效满意.     

Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography. A prospective study of 35 patients.

STUDY DESIGN: This was a prospective study of 35 consecutive patients in whom pedicle screw position was assessed after surgery, using lateral radiographs and computed tomography. OBJECTIVE: To evaluate the accuracy of plain radiographs and computed tomography in assessment of pedicle screw position. SUMMARY OF BACKGROUND DATA: Imaging techniques, such as postoperative anteroposterior and lateral plain radiographs and computed tomography, are currently the primary means of assessing pedicle screw placement. METHODS: Postoperative radiographs and computed tomographic scans were used to evaluate the position of 220 pedicle screws inserted in the spines of 35 consecutive patients who underwent thoracic and lumbar spine fusion and instrumentation. No recognized neurologic complication resulted from pedicle screw placement. Screw position was graded as in, out, or questionable. All observations were performed independently by three observers. The authors also analyzed the position of the screws according to the underlying spinal disease. RESULTS: More misplaced screws were clearly seen on computed tomographic scans than on plain radiographs; however, this difference was not statistically significant. Interobserver differences were not statistically significant. Intraobserver differences approached statistical significance when the results of the two test were compared. CONCLUSIONS: Although the accuracy of computed tomographic imaging is better than that of plain radiographs, the difference does not reach statistical significance. Postoperative use of plain radiographs remains a reliable method for evaluation of pedicle screw insertion in the absence of neurologic deficit.     

带预警装置椎弓根螺锥的临床应用

目的探讨带预警装置椎弓根螺锥在胸腰椎手术应用中的优越性。方法回顾性研究自2010年9月~2011年10月收治的需进行椎弓根钉系统内固定的胸腰椎疾病30例,其中腰椎间盘突出16例,胸腰椎骨折10例,椎体滑脱4例。在减压解除神经压迫或复位椎体的同时利用带预警装置椎弓根螺锥行椎弓根钉固定。结果共置入160枚螺钉,术中及术后X线片评估椎弓根钉置钉准确度为100%,术后三维影像评估螺钉位置准确率为94.4%,螺钉平均置入时间(4.5±0.7)min/枚,未出现螺钉置入相关的近期并发症。结论在胸腰椎手术中应用带预警装置椎弓根螺锥行椎弓根钉置入,可有效提高置钉的精确性、安全性,缩短手术时间、减少术中出血量及放射线的暴露强度。     

Translaminar screw fixation in the lumbar spine: technique, indications, results

Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after discectomies, and painful disc-related syndromes such as internal disc disruption and lumbar disc herniation with concomitant degenerative changes. As an additional stabilization procedure, translaminar screws can be used to augment anterior fusion or reinforce pedicle systems. Translaminar screw fixation achieves as high fusion rate provided the biomechanical principles of the lumbar spine with an intact anterior column are respected and a meticulous operative technique is employed to enhance bony ingrowth of the graft. Received: 12 January 1998 Revised: 18 March 1998 Accepted: 6 April 1998     

显微内镜辅助经皮微创椎间孑L入路腰椎椎体间融合术治疗腰椎退行性疾病

背景：传统开放椎间孔入路腰椎椎体间融合术（transforaminal lumbar interbody fusion,TLIF）由于剥离肌肉广泛及长时间牵拉,可导致部分患者持续性腰背痛。随着脊柱微创技术的发展,采用微创手段实施TLIF技术取得了良好的临床效果,但小切口经扩张通道系统的微创TLIF仍不可避免存在肌肉剥离,需探索更加微创的手术方式。 目的：探讨显微内镜辅助经皮微创TLIF治疗腰椎退行性疾病的近期疗效及安全性。 方法：2010年9月至2011年7月,72例腰椎退行性疾病患者接受了单节段TLIF手术,腰椎失稳症36例,腰椎管狭窄症25例,复发型腰椎间盘突出症11例。采用VIPER经皮椎弓根螺钉系统结合椎间盘镜下TLIF手术32例（微创组）,传统开放TLIF手术40例（开放组）,对两组患者近期临床疗效、并发症、术中射线暴露指标等进行比较。 结果：所有患者均获随访,随访时间6-15个月,平均9个月。两组手术时间无明显统计学差异（P〉0．05）,微创组术中出血量、伤口引流量、住院天数、术后应用镇痛药剂量均明显低于开放组（P〈0．01）;微创组术中射线暴露时间及剂量高于开放组（P〈0．01）;微创组术后疼痛（VAS评分）及ODI功能指数较开放组明显降低（P〈0．01）。微创组出现术中减压错误1例,置钉位置错误1例,导针穿透椎体前壁1例,硬膜撕裂1例;开放组出现术中硬膜撕裂3例,术后伤口浅表感染1例。两组患者均未出现神经损伤并发症。 结论：显微内镜辅助经皮微创TLIF较传统开放手术具有创伤小、出血少、恢复快、住院时间短等优点,具有良好的近期疗效,是治疗腰椎失稳症值得推荐的微创手术方式。     

Complications of pedicle screw fixation in reconstructive surgery of the cervical spine

STUDY DESIGN: Retrospective evaluation of complications in 180 consecutive patients with cervical disorders who had been treated by using pedicle screw fixation systems. OBJECTIVES: To determine the risks associated with pedicle screw fixation in the cervical spine and to emphasize the importance of preoperative planning and surgical techniques in reducing the risks of this procedure. SUMMARY OF BACKGROUND DATA: Generally, pedicle screw fixation in the cervical spine has been considered too risky for the neurovascular structures. There have been several reports describing the complications of lateral mass screw-plate fixation. However, no studies have examined in detail the complications associated with cervical pedicle screw fixation. METHODS: One hundred eighty patients who underwent cervical reconstructive surgery using cervical pedicle screw fixation were reviewed to clarify the complications associated with the pedicle screw fixation procedure. Cervical disorders were spinal injuries in 70 patients and nontraumatic lesions in 110 patients. Seven hundred twelve screws were inserted into the cervical pedicles, and the locations of 669 screws were radiologically evaluated. RESULTS: Injury of the vertebral artery occurred in one patient. The bleeding was stopped by bone wax, and no neurologic complication developed after surgery. On computed tomographic (CT) scan, 45 screws (6.7%) were found to penetrate the pedicle, and 2 of 45 screws caused radiculopathy. Besides these three neurovascular complications directly attributed to screw insertion, radiculopathy caused by iatrogenic foraminal stenosis from excessive reduction of the translational deformity was observed in one patient. CONCLUSIONS: The incidence of the clinically significant complications caused by pedicle screw insertion was low. Complications associated with cervical pedicle screw fixation can be minimized by sufficient preoperative imaging studies of the pedicles and strict control of screw insertion. Pedicle screw fixation is a useful procedure for reconstruction of the cervical spine in various kinds of disorders and can be performed safely.     

Direct repair of multiple levels lumbar spondylolysis by pedicle screw laminar hook and bone grafting: clinical, CT, and MRI-assessed study

INTRODUCTION: A prospective analysis of 6 cases with multiple-level spondylolysis treated by direct repair with pedicle screw laminar hook is presented. The objective of the study was to evaluate the clinical outcome, plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging to demonstrate the result of direct repair in the treatment of multiple-level spondylolysis. MATERIALS AND METHODS: Ten patients with multiple-level spondylolysis of lumbar spine were treated with segmental pedicle screw hook fixation and autogenous bone graft. Four patients had lost follow-up. Six patients were followed up for a minimum of 2 years (mean 34.3 mo, range 24 to 55 mo). Patient's average age was 22 years old (range from 20 to 25 y old). All lytic defects were bilateral and located at 2 different lumbar vertebras (levels). CT scans and MR images were obtained at the latest follow-up postoperatively to assess the healing of the bony defects and the adjacent disc conditions. Fusion was considered to be presented when trabecula across the lytic defect was detected. RESULTS: The union rate was 87% (21 pars/24 pars) on plain radiographs and 75% (18 pars/24 pars) on CT scans. Follow-up magnetic resonance imaging of lumbar spine showed no disc degeneration. All patients were satisfied (either excellent or good) with the postoperative outcomes. CONCLUSIONS: Direct repair of multiple-level spondylolysis by pedicle screw laminar hook and autogenous bone graft would be the alternative of treating patients with persistent back pain after 6 months of conservative treatment The favorable clinical outcome was correlated with bony healing rate in this series.     

三叠转盘卡在颈椎椎弓根内固定术中的临床应用

目的探讨自创二三叠转盘卡在颈椎骨折脱位椎弓根内固定术的临床应用效果。方法2007年1月至2012年12月,基于国人颈椎解剖生理及影像学数据,自创三叠转盘卡。采用转盘卡定位对66例颈椎骨折脱位伴2节段以上脊髓损伤的患者实行颈椎侧块螺钉联合椎弓根螺钉治疗,其中男40例,女26例;年龄19—77岁,平均45岁。均行颈椎CT、MRI检查,颈髓损伤2节段36例,颈髓损伤2节段以上30例。损伤类型：32例一侧关节突骨折伴脱位,16例双侧关节突骨折伴脱位,18例椎板骨折脱位。脊髓功能评价：依据Frankel分级标准,A级19例,B级16例,C级16例,D级15例;人院平均JOA评分5．92分。结果术后随访3—24个月,平均13．5个月。术后颈椎完全复位65例,复位不完全1例。依据术前、术后JOA评分结果,术后改善率平均为62％;术后Frankel分级平均提高1级以上;椎弓根螺钉植人准确度为97．2％。结论颈椎椎弓根三叠转盘卡,在术中应用准确、安全、便捷,置钉准确率高,有利于患者脊髓神经功能的恢复,对颈椎椎弓根螺钉的置钉有较好的指导作用,为临床治疗提供了一种实用工具。