单纯前后位透视下经皮椎弓根穿刺术的临床应用

Clinical evaluation of percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance

中文关键词:  前后位透视  经皮椎弓根螺钉  腰椎

英文关键词:Anterior-posterior fluoroscopic imaging  Percutaneous pedicle screw  Lumbar spine

中文摘要:

  【摘要】 目的：探讨单纯前后位透视下经皮椎弓根穿刺置钉的可行性与安全性。方法：2011年10月~2013年6月，共有40例腰椎退变性疾病患者接受单节段经皮椎弓根钉棒内固定、椎体间融合术（MIS-TLIF），其中采用单纯前后位透视下经皮椎弓根穿刺置钉的患者20例（观察组），采用正、侧位透视下经皮椎弓根穿刺置钉的患者20例（对照组）。术前在CT横断面影像上测量患者L1~S1椎体的双侧椎弓根长度，并取其算术平均值作为穿刺深度的参考。比较两组患者手术的椎弓根穿刺时间和穿刺过程中的射线暴露时间、面积剂量乘积、皮肤入射剂量及手术并发症，术后复查超薄螺旋CT明确椎弓根穿刺置钉的准确性。结果：L1~S1椎体椎弓根的平均长度分别为19.7±0.6mm、19.6±0.6mm、19.0±0.8mm、18.8±0.8mm、18.4±0.8mm和16.3±1.3mm。40例患者均安全接受手术，共置入160枚椎弓根螺钉，无与穿刺相关的神经、血管并发症，观察组患者椎弓根穿刺时间和穿刺过程中的射线暴露时间、面积剂量乘积及皮肤入射剂量均少于对照组，差异具有统计学意义（P<0.05）。术后复查超薄螺旋CT可见观察组1例、对照组2例出现椎弓根皮质的1级穿透，两组椎弓根置钉准确率无统计学差异（P>0.05）。结论：单纯前后位透视下经皮椎弓根穿刺术安全、操作简单、射线辐射量少，是一种较理想的微创经椎弓根穿刺置钉方法。

英文摘要:

  【Abstract】 Objectives: To evaluate effectiveness and safety of percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance. Methods: From October 2011 to June 2013, 40 cases suffering fromlumbar degenerative diseases were included in this study. 20 of them underwent percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance(observational group). While the other 20 patients underwent percutaneous pedicle cannulation and screws insertion(one level) by routine anterior-posterior and lateral fluoroscopic imaging guidance(control group). For these 40 cases, bilateral pedicle lengths of five lumbar vertebrae(from L1 to L5) and sacrum 1(S1) were measured by using transverse computed tomography(CT) images before operation. Their arithmetic mean value was calculated as the reference of cannulation length. Time length, intraoperative radiation exposure time, dose area product, skin irradiation dose during pedicle cannulation and intraoperative complication of patients in both groups were recorded and analyzed. Ultrathin spiral CT was used to confirm the accuracy of pedicle screw insertion in both groups. Results: Pedicle length from L1 to S1 was 19.7±0.6mm, 19.6±0.6mm, 19.0±0.8mm, 18.8±0.8mm, 18.4±0.8mm, 16.3±1.3mm respectively among 40 cases. 160 pedicle screws were safely inserted, and no intraoperative complication related with cannulation was noted. Time length, intraoperative radiation exposure time, dose area product and skin irradiation dose during pedicle cannulation in observational group were lower than those in control group(P<0.05). 1 case in observational group and 2 cases in control group experienced pedicle perforation, which was revealed by ultrathin spiral CT postoperatively. However, there was no statistical significance(P>0.05). Conclusions: Percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance is of high safety, simplified manipulation, decreased radiation exposure, which appears to be a favorable alternative option.