Clinical application of vertebral arch-transverse pathway in pedicle screw implantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Hui ¹ , CHEN Jianming ¹ , ZHANG Chengcheng ¹ , LI Zhanqing ¹ ,  LU Sheng ²

1. Department of Spine Surgery, the 926 Hospital of Joint Logistics Support Force of Chinese PLA, Kaiyuan Yunnan, 661600, P.R.China;
2. Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming Yunnan, 650032, P.R.China;

Corresponding?author：

LU Sheng, Email: dlusheng@163.com

Keywords：

Thoracic vertebra; vertebral arch-transverse pathway; screw implantation; internal fixation

DOI：

10.7507/1002-1892.201810124

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Objective To investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial.Methods Twenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation.Results The time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ²=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ²=4.125, P=0.021].Conclusion Compared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.

Citation： ZHONG Hui, CHEN Jianming, ZHANG Chengcheng, LI Zhanqing, LU Sheng. Clinical application of vertebral arch-transverse pathway in pedicle screw implantation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1486-1490. doi: 10.7507/1002-1892.201810124 Copy

1.	Kim SB, Won Y, Yoo HJ, et al. Unilateral spinous process noncovering hook type patient-specific drill template for thoracic pedicle screw fixation: a pilot clinical trial and template classification. Spine (Phila Pa 1976), 2017, 42(18): E1050-E1055.
2.	Blizzard DJ, Thomas JA. MIS single-position lateral and oblique lateral lumbar interbody fusion and bilateral pedicle screw fixation: feasibility and perioperative results. Spine (Phila Pa 1976), 2018, 43(6): 440-446.
3.	陳雍君, 華強, 段少銀, 等. 新型上胸椎椎弓根釘內固定系統的設計及其生物力學分析. 中國骨與關節損傷雜志, 2017, 32(9): 905-908.
4.	華饒鋒, 占振宇. 椎弓根釘固定及橫突間植骨融合治療腰椎滑脫癥23例. 中國骨傷, 2001, 14(10): 628.
5.	鐘暉, 陸聲, 陳建明, 等. 胸椎" 椎弓根-橫突通道”的結構分析及經此通道置釘的可行性研究. 解放軍醫藥雜志, 2019, 31(2): 81-85.
6.	黃山, 李祥志. 胸腰椎骨折前路手術中導針定位椎體螺釘置入. 創傷外科雜志, 2019, 21(1): 26-31.
7.	王永慶, 田偉, 張貴林, 等. 下胸椎手術患者椎弓根螺釘置入方法及置釘效果觀察. 山東醫藥, 2015, 55(20): 67-68.
8.	陳斌. 椎弓根釘內固定加橫突間植骨融合治療腰椎間盤突出癥臨床觀察. 中國傷殘醫學, 2015, 23(9): 43-44.
9.	Fan Chiang CY, Tsai TT, Chen LH, et al. Computed tomography-based navigation-assisted pedicle screw insertion for thoracic and lumbar spine fractures. Chang Gung Med J, 2012, 35(4): 332-338.
10.	謝雁春, 項良碧, 于海龍, 等. 引導通道輔助下經皮椎弓根置釘與傳統經皮椎弓根置釘的比較. 中國脊柱脊髓雜志, 2016, 26(3): 254-258.
11.	Tzermiadianos MN, Renner SM, Phillips FM, et al. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
12.	張鵬. 60例胸腰椎骨折經傷椎椎弓根植骨結合后路釘棒內固定治療的臨床應用. 影像研究與醫學應用, 2018, 2(4): 46-47.
13.	王潤生, 毛克亞, 黃承軍, 等. 微創經椎間孔腰椎椎間融合術中采用橫突定位法置釘的影像學評價. 中國脊柱脊髓雜志, 2018, 28(4): 336-342.
14.	Sugimoto Y, Ito Y, Tomioka M, et al. Clinical accuracy of three-dimentional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion. Acta Med Okayama, 2017, 64(3): 209-212.
15.	馮殿鵬, 劉廣慧, 姜泳. 經后路椎弓根釘棒系統治療強直性脊柱炎合并胸腰椎骨折臨床研究. 中國實用醫藥, 2019, 14(12): 73-74.
16.	Lien SB, Liou NH, Wu SS. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J, 2007, 16(8): 1215-1222.

1. Kim SB, Won Y, Yoo HJ, et al. Unilateral spinous process noncovering hook type patient-specific drill template for thoracic pedicle screw fixation: a pilot clinical trial and template classification. Spine (Phila Pa 1976), 2017, 42(18): E1050-E1055.
2. Blizzard DJ, Thomas JA. MIS single-position lateral and oblique lateral lumbar interbody fusion and bilateral pedicle screw fixation: feasibility and perioperative results. Spine (Phila Pa 1976), 2018, 43(6): 440-446.
3. 陳雍君, 華強, 段少銀, 等. 新型上胸椎椎弓根釘內固定系統的設計及其生物力學分析. 中國骨與關節損傷雜志, 2017, 32(9): 905-908.
4. 華饒鋒, 占振宇. 椎弓根釘固定及橫突間植骨融合治療腰椎滑脫癥23例. 中國骨傷, 2001, 14(10): 628.
5. 鐘暉, 陸聲, 陳建明, 等. 胸椎" 椎弓根-橫突通道”的結構分析及經此通道置釘的可行性研究. 解放軍醫藥雜志, 2019, 31(2): 81-85.
6. 黃山, 李祥志. 胸腰椎骨折前路手術中導針定位椎體螺釘置入. 創傷外科雜志, 2019, 21(1): 26-31.
7. 王永慶, 田偉, 張貴林, 等. 下胸椎手術患者椎弓根螺釘置入方法及置釘效果觀察. 山東醫藥, 2015, 55(20): 67-68.
8. 陳斌. 椎弓根釘內固定加橫突間植骨融合治療腰椎間盤突出癥臨床觀察. 中國傷殘醫學, 2015, 23(9): 43-44.
9. Fan Chiang CY, Tsai TT, Chen LH, et al. Computed tomography-based navigation-assisted pedicle screw insertion for thoracic and lumbar spine fractures. Chang Gung Med J, 2012, 35(4): 332-338.
10. 謝雁春, 項良碧, 于海龍, 等. 引導通道輔助下經皮椎弓根置釘與傳統經皮椎弓根置釘的比較. 中國脊柱脊髓雜志, 2016, 26(3): 254-258.
11. Tzermiadianos MN, Renner SM, Phillips FM, et al. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
12. 張鵬. 60例胸腰椎骨折經傷椎椎弓根植骨結合后路釘棒內固定治療的臨床應用. 影像研究與醫學應用, 2018, 2(4): 46-47.
13. 王潤生, 毛克亞, 黃承軍, 等. 微創經椎間孔腰椎椎間融合術中采用橫突定位法置釘的影像學評價. 中國脊柱脊髓雜志, 2018, 28(4): 336-342.
14. Sugimoto Y, Ito Y, Tomioka M, et al. Clinical accuracy of three-dimentional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion. Acta Med Okayama, 2017, 64(3): 209-212.
15. 馮殿鵬, 劉廣慧, 姜泳. 經后路椎弓根釘棒系統治療強直性脊柱炎合并胸腰椎骨折臨床研究. 中國實用醫藥, 2019, 14(12): 73-74.
16. Lien SB, Liou NH, Wu SS. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J, 2007, 16(8): 1215-1222.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of vertebral arch-transverse pathway in pedicle screw implantation

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