| Objective:Pedicle screw internal fixation technique is a "milestone" internal fixation technique in spinal surgery.Currently,it has been widely used in various spinal diseases and achieved satisfactory results.However,due to the complex adjacent structure of the pedicle,misplacement of the pedicle screws may lead to complications of vascular,nerve and even visceral injury.To address the above problems,this study designed a new location method for single level lumbar pedicle screw entry point,and discussed its accuracy and safety.Methods: Study 1: A total of 98 patients with lumbar single-level disc herniation were collected from January 2019 to August 2020.All patients underwent posterior lumbar discectomy and decompression with interbody fusion and pedicle screw fixation.According to the operation plan,98 patients were divided into experimental group and control group.Among them,53 patients in the experimental group were treated with the new method of nail entry point positioning,that is,the intersection of 4 mm below the upper edge of the transverse process and the outer edge of the superior articular process was used as the point of entry,while 45 patients in the control group were treated with the traditional Herr crest method,that is,the intersection of the longitudinal ridge structure of the lumbar isthmus and the root of the superior articular process.The duration of surgery,intraoperative blood loss,initial nail placement accuracy,incision exposure time,the relationship between screws and the pedicle cortex,and possible complications were compared between the two groups.The visual Analogue Scale(VAS)was used to determine the degree of pain.Study 2: In addition,we evaluated the accuracy and clinical efficacy of this new approach in 64 patients with hermite-ridge indistinguishable lumbar single segment.Results: In study 1: 212 screws were implanted in the experimental group and 180 screws in the control group.Operation duration of experimental group(87.8±14.5)and control group(85.4±11.3),intraoperative blood loss of experimental group(190.4±59.2)and control group(194.0±44.5),and postoperative VAS score of experimental group(1.6±0.9)and control group(1.8±0.8)The difference was not statistically significant(P > 0.05);The incision exposure time before nail placement in experimental group was shorter than that in control group,the difference was statistically significant(P < 0.05).The accuracy of the first screw placement in the experimental group was 97.2%(206/212)better than that in the control group 92.2%(166/180).The relationships between screws and the pedicle cortex in the experimental group were as follows: excellent(96.6%),good(3.4%)and the relationships between screws and the pedicle cortex in the control group: Excellent(96.7%)and good(3.3%)were similar,and both groups were in the safety zone.Study 2: In addition,64 patients with lumbar single-level disc herniation were found to have unclear identification of the apex of hermitus ridge during the operation,and the accuracy rate of initial nail placement by this method reached 97.6%(276/286).All screws were clearly placed in the safe zone by postoperative plain CT scan: 204patients(79.7%)is excellent and 52 patients(20.3%)is good.Conclusion: According to the study,the intersection of the lumbar vertebra 4 mm below the upper edge of the transverse process and the outer edge of the superior articular process was used as the insertion point,which could obtain the same safety as the traditional Herr crest positioning method,and the accuracy of the first intraoperative nail placement was slightly higher than that of the traditional Herr crest method,and the exposure time of the incision before nail placement could be shortened.This new method can achieve good clinical effect in the single segment of the lumbar spine with indistinct herringbone crest apex.It can be used as an innovative nail placement method and as a remedy when the mitral crest is not clearly identified,giving spine surgeons a new option. |
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