Silke Vißmann, Philippus Schöttes, Fatma Topcuoglu, Thorsten Strohmann, Jens-Peter Stahl, Stefan Rohde
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To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined.</p><p><strong>Results: </strong>Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found.</p><p><strong>Conclusion: </strong>The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Precision and safety of positioning pedicle screws in the thoracic and lumbar spine using a hand-guided aiming sleeve : A CT control study].\",\"authors\":\"Silke Vißmann, Philippus Schöttes, Fatma Topcuoglu, Thorsten Strohmann, Jens-Peter Stahl, Stefan Rohde\",\"doi\":\"10.1007/s00113-023-01392-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable.</p><p><strong>Objective: </strong>Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. 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引用次数: 0
摘要
背景:在椎弓根螺钉的植入中,导航支持系统的应用越来越多,它可以使螺钉的方向更加可预测,从而避免螺钉错位。目的:探讨手导瞄准套置入椎弓根螺钉后的精度。目的是通过仅使用2D X光片验证椎弓根螺钉的实施是可计划的和精确的。方法:回顾性分析27例连续创伤椎体骨折患者(17-84岁,13f/14m)。研究了108颗采用手导瞄准套植入的螺钉的定位和精度。为了确定螺钉的位置,使用术后3D CT数据集(GE Optima 540, General Electric Company Boston, MA, USA;切片厚度1.25 mm)。然后将螺钉与先前定义的螺钉尖端的理想位置进行比较。除了确定与理想目标点的绝对和相对偏差外,还确定了收敛角和与盖板的平行度。结果:108枚植入椎弓根螺钉,90枚(83%)命中目标。其余18例(17%)为与临床无关的螺钉偏移:17例椎弓根螺钉发生外侧偏移(16%),1例发生内侧偏移(1%)。与椎体理想靶点的平均腹侧偏差为2.3 mm,标准差为± 2.3 mm。无螺钉错位或椎弓根穿孔。结论:手导瞄准套经皮椎弓根螺钉置入胸腰椎是一种安全、精确的手术方法。与文献报道的其他导航螺钉植入方法相比[1-6],该方法需要矫正的错位风险较低。基于ct的初步规划是不必要的。该方法经济,不需要特殊的技术设备。
[Precision and safety of positioning pedicle screws in the thoracic and lumbar spine using a hand-guided aiming sleeve : A CT control study].
Background: For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable.
Objective: Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. The aim was to verify that the implementation of the pedicle screws is plannable and precise by using 2D X‑ray only.
Method: This retrospective study analyzed 27 consecutive trauma patients (17-84 years, 13f/14m) with vertebral body fractures. The position and precision of 108 screws, implanted using the hand-guided aiming sleeve was investigated. To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined.
Results: Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found.
Conclusion: The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.