球形探针技术在胸腰椎椎弓根螺钉置钉中的应用

目的通过与传统开路锥置钉技术比较,评价在胸腰椎椎弓根螺钉置钉中应用球形探针技术的准确性和安全性,探讨其临床应用价值。方法回顾性分析2016年1月—2017年2月新疆医科大学第一附属医院收治的需行胸腰椎椎弓根螺钉内固定治疗的106例患者临床资料,术中应用球形探针技术或传统开路锥技术置入椎弓根螺钉。其中56例采用直径2.5 mm球形探针穿刺(球形探针组),其余50例采用传统开路锥穿刺(传统组)。术后采用CT检查确认螺钉位置以评估置钉准确性。结果球形探针组共置入椎弓根螺钉296枚,传统组共置入264枚。术后CT显示球形探针组置钉准确率为97.64%,7枚置钉不良;传统组置钉准确率为83.71%,43枚置钉不良。2组置钉准确率及穿透椎弓根内侧、椎弓根外侧、椎体前壁骨皮质螺钉比例差异均有统计学意义(P<0.05)。2组术中出血量间差异无统计学意义(P>0.05)。传统组术后1例出现L5神经根损伤致足下垂;球形探针组术中、术后均未出现神经、血管、脑脊液漏或内脏损伤等并发症。结论与传统开路锥置钉技术相比,球形探针技术能更准确置入胸腰椎椎弓根螺钉,减少因螺钉位置不良导致的并发症。

Application of ball tip technique for thoracolumbar pedicle screw placement

Objective To evaluate the efficacy and safety of the ball tip technique in thoracolumbar pedicle screw placement by comparing it with the traditional open-circuit cone screw placement technique. Methods From January 2016 to February 2017, the clinical data of 106 patients admitted to the First Affiliated Hospital of Xinjiang Medical University who needed thoracolumbar pedicle screw internal fixation were retrospectively analyzed. Among them, 56 cases were evaluated in the ball tip group (with a diameter of 2.5 mm), and the remaining 50 received traditional open-circuit cone screw placement technique (traditional group). The accuracy of the pedicle screws placements was evaluated on postoperative CT. Results A total of 296 pedicle screws were inserted in the ball tip group, and 264 in the traditional group. Postoperative CT showed that the accuracy of screw placement in the ball tip group was 97.64%, and 7 were poor in screw placement. The accuracy of screw placement in the traditional group was 83.71%, and 43 were poor in screw placement. There were statistically significant differences in the accuracy of screw placement and the ratio of screws penetrating the medial, lateral cortical bone of the pedicle and the anterior cortical bone of the vertebral body between the 2 groups (P<0.05). There was no significant difference in intraoperative blood lo ss between the 2 groups(P>0.05). One patient in the traditional group suffered from L₅ nerve root injury and foot drop. No complications such as nerve, blood vessel and visceral injury, or cerebrospinal fluid leakage occurred during and after the operation in the ball tip group. Conclusion Compared with the traditional open-cone screw placement technique, the ball tip technique can more accurately insert the thoracolumbar pedicle screw and reduce the complications caused by screw mispalcement.