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.	陈雍君, 华强, 段少银, 等. 新型上胸椎椎弓根钉内固定系统的设计及其生物力学分析. 中国骨与关节损伤杂志, 2017, 32(9): 905-908.
4.	华饶锋, 占振宇. 椎弓根钉固定及横突间植骨融合治疗腰椎滑脱症23例. 中国骨伤, 2001, 14(10): 628.
5.	钟晖, 陆声, 陈建明, 等. 胸椎" 椎弓根-横突通道”的结构分析及经此通道置钉的可行性研究. 解放军医药杂志, 2019, 31(2): 81-85.
6.	黄山, 李祥志. 胸腰椎骨折前路手术中导针定位椎体螺钉置入. 创伤外科杂志, 2019, 21(1): 26-31.
7.	王永庆, 田伟, 张贵林, 等. 下胸椎手术患者椎弓根螺钉置入方法及置钉效果观察. 山东医药, 2015, 55(20): 67-68.
8.	陈斌. 椎弓根钉内固定加横突间植骨融合治疗腰椎间盘突出症临床观察. 中国伤残医学, 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.	谢雁春, 项良碧, 于海龙, 等. 引导通道辅助下经皮椎弓根置钉与传统经皮椎弓根置钉的比较. 中国脊柱脊髓杂志, 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.	张鹏. 60例胸腰椎骨折经伤椎椎弓根植骨结合后路钉棒内固定治疗的临床应用. 影像研究与医学应用, 2018, 2(4): 46-47.
13.	王润生, 毛克亚, 黄承军, 等. 微创经椎间孔腰椎椎间融合术中采用横突定位法置钉的影像学评价. 中国脊柱脊髓杂志, 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.	冯殿鹏, 刘广慧, 姜泳. 经后路椎弓根钉棒系统治疗强直性脊柱炎合并胸腰椎骨折临床研究. 中国实用医药, 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. 陈雍君, 华强, 段少银, 等. 新型上胸椎椎弓根钉内固定系统的设计及其生物力学分析. 中国骨与关节损伤杂志, 2017, 32(9): 905-908.
4. 华饶锋, 占振宇. 椎弓根钉固定及横突间植骨融合治疗腰椎滑脱症23例. 中国骨伤, 2001, 14(10): 628.
5. 钟晖, 陆声, 陈建明, 等. 胸椎" 椎弓根-横突通道”的结构分析及经此通道置钉的可行性研究. 解放军医药杂志, 2019, 31(2): 81-85.
6. 黄山, 李祥志. 胸腰椎骨折前路手术中导针定位椎体螺钉置入. 创伤外科杂志, 2019, 21(1): 26-31.
7. 王永庆, 田伟, 张贵林, 等. 下胸椎手术患者椎弓根螺钉置入方法及置钉效果观察. 山东医药, 2015, 55(20): 67-68.
8. 陈斌. 椎弓根钉内固定加横突间植骨融合治疗腰椎间盘突出症临床观察. 中国伤残医学, 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. 谢雁春, 项良碧, 于海龙, 等. 引导通道辅助下经皮椎弓根置钉与传统经皮椎弓根置钉的比较. 中国脊柱脊髓杂志, 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. 张鹏. 60例胸腰椎骨折经伤椎椎弓根植骨结合后路钉棒内固定治疗的临床应用. 影像研究与医学应用, 2018, 2(4): 46-47.
13. 王润生, 毛克亚, 黄承军, 等. 微创经椎间孔腰椎椎间融合术中采用横突定位法置钉的影像学评价. 中国脊柱脊髓杂志, 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. 冯殿鹏, 刘广慧, 姜泳. 经后路椎弓根钉棒系统治疗强直性脊柱炎合并胸腰椎骨折临床研究. 中国实用医药, 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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