The optimal introversion angle and length of pedicle screw to avoid L1-S1 vascular damage.

IF 1.6 3区医学 Q2 SURGERY

BMC Surgery Pub Date : 2024-06-21 DOI:10.1186/s12893-024-02483-3

Ying Chen, Junyi Yang, Jie Liang, Weifei Wu

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Abstract

Background: posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1.

Methods: Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), D_O-AVC (the distance between the origin (O) with anterior vertebral cortex (AVC)), D_AVC-PGVs (the distance between AVC and the prevertebral great vessels (PGVs)), D_O-PGVs (the distance between the O and PGVs). At different INTAs, D_AVC-PGVs were divided into four grades: Grade III: D_AVC-PGVs ≤ 3 mm, Grade II: 3 mm < D_AVC-PGVs ≤ 5 mm, Grade I: D_AVC-PGVs > 5 mm, and N: the not touching PGVs.

Results: The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1.

Conclusions: At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.

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避免 L1-S1 血管损伤的最佳椎弓根螺钉导入角度和长度。

背景：后路椎弓根螺钉固定术是一种常见的方法，最严重的并发症之一是先天性血管损伤，目前还没有报道研究不同内旋角度（INTA）和椎弓根螺钉长度的关联。本研究的目的是探讨提高手术安全性的最佳内旋角度和椎弓根螺钉长度，并分析 L1-S1 处血管损伤类型的差异：用 DICOM 软件分析 110 例患者的腰椎 CT 成像数据，并用新的直角坐标系、INTAs（L1-L5:5°,10°,15°,S1.0°,5°,10°）测量所有参数：INTA（L1-L5：5°,10°,15°，S1：0°,5°,10°,15°）、DO-AVC（原点（O）与椎体前皮质（AVC）之间的距离）、DAVC-PGVs（AVC 与椎体前大血管（PGVs）之间的距离）、DO-PGVs（O 与 PGVs 之间的距离）。在不同的 INTA，DAVC-PGV 被分为四个等级：III级：DAVC-PGVs ≤ 3 mm；II级：3 mm AVC-PGVs ≤ 5 mm；I级：DAVC-PGVs > 5 mm；N级：未触及PGVs：L1-L3的最佳INTA为5°，L4的左最佳INTA为5°，右最佳INTA为15°，L1-L4的螺钉长度小于50毫米。在 L5，左侧最佳 INTA 为 5°，右侧为 10°，螺钉长度小于 45 毫米。在 S1，最佳 INTA 为 15°，螺钉长度小于 50 毫米。然而，当S1的INTA为0°或5°时，螺钉长度小于40毫米：结论：在L5-S1，血管损伤的风险最高。结论：在腰椎手术中，INTA 和椎弓根螺钉的长度密切相关。3毫米的螺钉长度间隔可能更有利于减少血管损伤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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