目的 探討經傷椎椎弓根螺釘內固定治療胸腰椎骨折的臨床療效。 方法 2008年5月－2010年12月，選擇38例胸腰椎骨折患者，采用椎弓根螺釘固定傷椎及相鄰上下椎體。其中男28例，女10例；年齡21～65歲，平均36.5歲。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受傷至手術時間3～7 d，平均4.5 d。對患者手術前后椎體高度、矢狀面后凸Cobb角、神經功能Frankel分級變化等指標進行測量并隨訪。 結果 術后患者切口均Ⅰ期愈合。38例獲隨訪12～18個月，平均15個月。骨折均獲得骨性融合，無釘棒斷裂、無死亡或神經損傷加重患者。術后神經功能Frankel分級較術前有明顯改善（P＜0.05）。術后X線片復查示傷椎高度恢復達90%以上，外形正常；CT復查示椎管內有效矢狀徑恢復滿意，椎管前方無明顯骨性壓迫，傷椎椎體骨愈合良好。術后1、12個月時傷椎前、后緣高度及后凸Cobb角均較術前顯著改善（P＜0.05）；術后12個月隨訪椎體高度無丟失。 結論 經傷椎椎弓根釘復位、減壓、內固定治療胸腰椎骨折具有創傷小、固定節段少、脊柱穩定性好、能有效矯正及預防脊柱后凸畸形等優點。
目的:研究樞椎椎弓根關節突復合體的解剖結構特征,探討該解剖概念的臨床意義。方法:觀察80具樞椎干骨標本椎弓根關節突部位的解剖結構特征。并隨機抽取其中20具標本,在椎弓骨背側表面做樞椎經椎弓根螺釘固定及經關節(C1-2)螺釘固定釘道投影畫線,另2具標本按兩種螺釘內固定方式設置直徑3.5 mm釘道,并螺旋CT掃描多平面重建(MPR)釘道斷面影像,了解兩種釘道與椎弓根關節突結構的解剖關系。回顧性分析25例外傷致樞椎椎弓根關節突部位骨折的CT資料,包括其中12例樞椎螺釘內固定術后CT,研究該部位骨折特點及釘道所在的斷面解剖。結果:樞椎解剖學上,無嚴格定義下完整的椎弓根。而樞椎椎弓根關節突作為復合體,具有解剖結構上整體性特征,其周圍界線清楚。外傷致樞椎椎弓根關節突復合體骨折可分為椎弓根上關節突骨折、關節突間部骨折及單純上關節突骨折。樞椎經椎弓根螺釘固定及經關節(C1-2)螺釘內固定的釘道均通過椎弓峽部中心,但起點不同,走向不同。結論:樞椎椎弓根關節突復合體作為臨床解剖概念,具有解剖結構的完整性。明確該解剖概念及各構件對該區域骨折分類與螺釘內固定手術具有指導作用。
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
目的:探討后路寰樞椎椎弓根螺釘內固定的術前計劃方案,明確其手術指導意義。方法:選取經CT評估寰樞椎椎弓根螺釘置入可行的,并擬選擇該手術治療的上頸椎不穩患者15例,容積再現重建(VR)寰樞椎椎弓表面影像,了解個體椎弓后方表面解剖形態與骨性解剖標志。同時按寰樞椎椎弓根理想的釘道走行,多平面重建(MPR)個體椎弓根斷面影像。術前根據這些解剖影像設計手術暴露路經、理想的進釘點與釘道軌跡。術中按該術前計劃手術暴露,找到理想的進釘點并鉆孔置椎弓根螺釘。將術中觀察到的C1后弓及C2椎弓表面解剖,與術前CT重建影像對比。術后CT復查,評價螺釘置入情況。結果:15例術中觀察到的C1后弓及C2椎弓表面解剖特征與術前CT容積再現的影像一致。參照寰樞椎椎弓CT影像解剖制定術前計劃方案,術中按其逐一操作,手術簡單、直觀,無重要血管神經損傷,置釘準確。結論:根據CT容積再現與多平面重建的寰樞椎解剖影像,制定后路寰樞椎椎弓根螺釘內固定術前計劃方案,指導手術安全、可靠。
Objective To ascertain whether augmentation pedicle screw fixation with polymethylmethacrylate (PMMA) can enhance the stability of unstable thoracolumbar burst fractures of osteoporotic spine. Methods Six fresh frozen female osteoporotic spines (T10-L5) were harvested and an anterior and posterior columnunstable model of L1 was made. Each specimen was fixated with plate and the stability test were performed by flexion, extension, axial rotation and lateral bending. The test of fatigue was done with MTS 858.The tests were repeated after screws were augmented with PMMA. To compare the biomechanical stability of 6 different conditions:○anormal specimens(control), ○bdefectmodel fixed with plate, not augmented and not fatigued, ○cafter fatigued, not augmented, ○dscrews augmented with PMMA, not fatigued, ○e after augmented and fatigued. ResultsIn ○b,○d and ○e conditions, the ranges of motion(ROM) were 6.23±1.56，4.49±1.00，4.46±1.83 inflexion and 6.60±1.80，4.41±0.82，4.46±1.83 in extension. There was no significant difference (Pgt;0.05), they were significantly smaller than those in ○a and ○c conditions (8.75±1.88，1.47±2.25 and 8.92±2.97，12.24±3.08) (Plt;0.01).Conclusion The results demonstrated that augmentation pedicle screws fixation with PMMA can increase the stability of osteoporotic spine.
ObjectiveTo investigate the clinical application of three-dimensional (3D) printing technique combined with a new type of thoracic pedicle screw track detector in thoracic pedicle screw placement.MethodsAccording to the characteristics of thoracic pedicle and common clinical screw placement methods, a new type of thoracic pedicle screw track detector was independently developed and designed. The clinical data of 30 patients with thoracic vertebrae related diseases who underwent posterior thoracic pedicle screw fixation between March 2017 and January 2020 were retrospectively analysed. Among them, there were 18 males and 12 females with an average age of 56.3 years (range, 32-76 years). There was 1 case of thoracic disc herniation, 4 cases of thoracic canal stenosis, 2 cases of ossification of posterior longitudinal ligament of thoracic vertebra, 16 cases of thoracic trauma, 2 cases of thoracic infection, and 5 cases of thoracic canal occupation. Three-dimensional CT of the thoracic vertebra was routinely performed preoperatively, and the model of the patient’s thoracic vertebra was reconstructed and printed out. With the assistance of the model, preoperative simulation was performed with the combination of the new type thoracic pedicle screw track detector, and detected no nails after critical cortical damage. During operation, one side was randomly selected to use traditional hand screws placement (control group), and the other side was selected to use 3D printing technique combined with new type thoracic pedicle screw track detector to assist thoracic pedicle screws placement (observation group). The single screw placement time, adjustment times of single screw, and blood loss during screw placement were compared between the two groups. The accuracy of screw placement in the two groups was evaluated according to postoperative CT imaging data.ResultsThe single screw placement time, adjustment times of single screw, and blood loss during screw placement in the observation group were significantly less than those in the control group (P<0.05). Postoperative CT examination showed that the observation group had 87 screws of grade 1, 3 screws of grade 2, and the acceptable screw placement rate was 100% (90/90); the control group had 76 screws of grade 1, 2 screws of grade 2, 11 screws of grade 3, and 1 screw of grade 4, and the acceptable screw placement rate was 86.7% (78/90); showing significant difference in screw placement between the two groups (χ2=12.875, P=0.001). All patients were followed up 6-18 months, with an average of 11.3 months. There was no complication of vascular, nerve, spinal cord, or visceral injury, and screws or rods broken, and no patient was revised.ConclusionThe 3D printing technique combined with the new type of thoracic pedicle screw track detector assisted thoracic pedicle screw placement is convenient, and significantly improves the accuracy and safety of intraoperative screw placement, and overall success rate of the surgery.
【摘要】 目的 研究棘突頂端上下緣與椎弓根中心點水平面垂直距離的關系，為微創胸腰段脊柱內固定術椎弓根的體表定位提供實驗依據。 方法 20具完整脊柱骨標本，測量標本兩側胸11~腰2椎弓根中心點與棘突旁開距離（CO）、棘突上、下緣至椎弓根中心點水平面垂直距離（AC、BC），以棘突頂端的上、下緣為參照點確定椎弓根的最佳體表投影點。選取20例無神經癥狀的單節段椎體骨折男性患者；年齡23~54歲，平均37.6歲。損傷部位:胸11、胸12、腰1、腰2骨折椎體各5例。以棘突頂端上緣點為確定椎弓根中心的參考點，行經皮椎弓根螺釘固定，分別測定術前、術后相應椎體Cobb角。 結果 男、女性各椎體左右兩側CO、AC、BC比較差異均無統計學意義（Pgt;0.05）。男女組間相同椎體CO和BO及胸11、胸12椎體的AC比較差異均有統計學意義（Plt;0.05），腰1、腰2椎體的AC比較差異無統計學意義（Pgt;0.05）。男性或女性胸11~腰2的CO依次變大、AC和BC逐漸減小，各椎體間比較差異均有統計學意義（Plt;0.01）。臨床應用顯示，術前、術后相應椎體Cobb角比較，差異均有統計學意義（Plt;0.05）。 結論 棘突頂端上緣為確定椎弓根中心點的最佳參照點，微創脊柱內固定術體表定位椎弓根時應根據性別和具體骨折椎體確定進針點。【Abstract】 Objective To study the anatomic distances from the upper and lower edges of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch, to provide assistance for the percutaneous positioning of the pedicle of vertebral arch in minimally-invasive transpedicular internal fixation for the thoracic and lumbar vertebrae. Methods We studied 20 integral thoraco-lumbar vertebrae samples, and the distance between the vertical plane including the upper and lower points of the spinous process peak and the horizontal plane of the center of pedicle of vertebral arch was measured and marked as CO. We also measured the distances from the upper and lower points of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch and marked them as AC and BC respectively. The upper and lower points of the spinous process peak were designated as reference points to define the optimal body surface projective point of the pedicle of vertebral arch. Twenty male patients with single segmental fractured vertebral body and without nervous symptoms were selected. The age of the patients were ranged from 23 to 54 years old, averaging at 37.6. The fractured vertebral bodies included T11, T12, L1, and L2 with 5 cases for each of them. The percutaneous transpedicular internal fixation was carried out with the upper point of the spinous process peak as the reference point to define the body surface projective point of the pedicle of vertebral arch and the preoperative and postoperative Cobb angle of each fractured vertebral body were measured. Results There was no significant differences in CO, AC and BC on both sides between male and female (Pgt;0.05). Statistical difference existed between male and female in CO and BO of the same vertebra, and AC of T11 and T12 (Plt;0.05), while AC of L1 and L2 had no significant difference (Pgt;0.05). In both males and females, CO of the vertebrae from T11 to L2 increased, while AC and BC decreased, and there was a significant difference among different vertebrae (Plt;0.01). Clinical application showed there was a significant difference between the Cobb angle before operation and that after operation (Plt;0.05). Conclusion The upper point of the spinous process peak is the best reference point to define the center of pedicle of vertebral arch. Deciding on the needle insertion spot should be based on gender and specific vertebral body, when minimally-invasive transpedicular internal fixation is performed to define the body surface projective point of the pedicle of vertebral arch.
Objective To develop a high-accuracy, better-safety and low-cost cervical pedicle locator system for guiding cervical pedicle screw placement. Methods Cervical pedicle screw locator system was made of stainless steel. Ten cervical specimens from voluntary donation were divided into two groups according to compatibil ity design: control group inwhich 60 screws were planted into C2-7 by free hand; and experimental group in which 60 screws were planted into C2-7 under the guidance of three-dimensional locator system. The condition of screw insertion was observed and the accuracy was evaluated by the integrity of pedicle walls. Results In the control group, 32 screws (53.33%) were placed inside the pedicles and 28 (46.67%) were outside; 9 screws (15.00%) led to nerve root injury, 5 screws (8.33%) caused vertebral artery injury and no spinal cord injury occurred; and the qual ification ratio of screw insertion was 76.67% (excellent 32, fair 14, poor 14). While in the experimental group, 54 screws (90.00%) were placed inside the pedicles and 6 (10.00%) were outside; 1 screw (1.67%) caused vertebral artery injury and no nerve root injury and spinal cord injury occurred; and the qual ification ratio of screw insertion was 98.33% (excellent 54, fair 5, poor 1). There was significant difference between the two groups (P lt; 0.05). Conclusion Cervical pedicle screw locator system has the advantages of easy manipulation, high accuracy of screw placement and low cost. With further study, it can be appl ied to the cl inical.
ObjectiveTo explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. MethodsTwenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. ResultsBoth groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. ConclusionThe new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.