Li Ming, Li Shaohua, Hou Tiesheng, and so on. Preliminary report on the treatment of cervical fracture and dislocation with APOF1X internal fixation system. Chinese Journal of Spinal Cord and Spinal Cord, 2000. Journal of Bone and Joint Injury, 200ft15(1): 3―5. 15 Revised Date: 200 Bu 12-12 This article is edited: Cheng Chunkai has multiple metal surface markers located in pedicle screw fixation Application of Zhou Qijia, Li Laichang, Guo Xionghu (Department of Orthopaedics, Suining People's Hospital, Suining 224400, China) The pedicle screw internal fixation system has been widely used in spine surgery, but it is prone to pedicle positioning. From February 1991 to December 1999, the author conducted a number of metal body surface markers and intraoperative positioning of pedicles. The results are reported below.
1 Materials and Methods 1.1 Observed subjects with acute thoracolumbar instability and lumbar spondylolisthesis in 42 cases, including 34 males and 8 females; aged 18 to 58 years, mean 36 years old. Dick, SF fixation, reduction, bone grafting. The patients were randomly divided into the preoperative metal marker localization group (group A) in 22 cases and the intraoperative pedicle positioning group (group B) in 20 cases. Patients with severe systemic diseases such as bleeding constitution are not included in the observation.
1.2 positioning method 1.2.1 metal body surface marker positioning prone on the hard bed before surgery, fully exposed to avoid skin wrinkles. After the paper clip bite and grow 5 mm, it is placed on the skin of the pedicle surface to be fixed, that is, the intersection of the parallel line of the upper edge of the spinous process and the vertical line of 15 mm. Position 6 pedicles, apply a long strip of rubber plaster, pay attention to protect against falling off. Take a positive X-ray film, according to the position of the metal mark and the actual pedicle position, the true pedicle position is marked with gentian violet on the body surface, and the iodine is fixed. Combined with intraoperative bone markers.
1.2.2 intraoperative pedicle positioning to find the location marker Weinstein point, the lumbar pedicle is the horizontal extension line of the lateral extension of the superior articular process and the horizontal axis of the transverse process. The fixed landmark of the lateral epiphysis of the lamina is close to the outer top of the epiphysis. The pedicle of the thoracic pedicle is located at the intersection of the lower edge of the thoracic facet joint and the midline of the facet joint. 3.1.3 observation index 1 operation time; 2 bleeding volume, including intraoperative and 48h drainage after surgery; 3 pedicle Nail position. X-ray films were taken 1 to 2 weeks after surgery.
1.4 Statistical analysis The count data was analyzed by X test, and the measurement data was analyzed by t test.
2 Results The average operation time of operation group was group A (125±65) minB group (175 groups were significantly different (P<0.05).
The amount of bleeding in group A was (600 2.3 pedicle screw position group B was mistakenly inserted into vertebral pedicle in 6 cases, the incidence rate was 9%; 4 cases were not accurately drilled into pedicle, the incidence rate was 4.5%.A The group did not enter the injured vertebrae, and 1 case was not accurately drilled. The incidence rate was 1%. There was a significant difference between the two groups (P<0.05).
3 Discussion 3.1 Intraoperative positioning of the defect After the spine fracture and dislocation, the normal anatomical structure has changed, especially the destruction of the posterior structure of the spine, such as extensive laminar fracture, interspinous ligament rupture, positioning is easy to enter the injured vertebral pedicle . Yang Huilin and others believe that even if the posterior column has no damage, the positioning is more difficult. The position of the pedicle is equivalent to 1/2 of the vertebral body. The lower edge of the corresponding spinous process is equivalent to the upper part of the lower vertebral body, and the two are almost one segment apart. In the early stage of this group, 3 cases were mistakenly inserted into the vertebral pedicle. If the pedicle screw bone is not sexy enough, it is still not clear to change the E angle and the F angle. Especially when the articular process and the transverse process are fractured as the positioning marks, the pedicle positioning is more likely to be inaccurate. It is often necessary to fully expose the articular processes and transverse processes until the pedicle position is clearly seen, which is bound to increase the amount of surgical trauma and bleeding.
3.2 Feasibility and Advantages of Metal Marking Positioning The magnification of the X-ray film and the mobility of the skin are the Achilles heel of the positioning of the metal body surface. The position during positioning is consistent with the position during surgery. The metal marker closest to the pedicle in the X-ray film is selected, and the corresponding pedicle is marked on the body surface. Due to the use of multiple metal marks, it is possible to avoid the magnification factor of the X-ray film and ensure that the skin is in the corresponding position. In combination with the bony mark in operation, the problem of skin movement can be solved.
Finding the pedicle surface projection through multiple metal markers, as a non-invasive positioning method, combined with intraoperative touch bone markers and surgical experience, will not accidentally enter the injured vertebrae, improve the drilling of a hole The success rate; thus reducing the amount of surgical trauma and bleeding, shortening the operation time, is an auxiliary method for pedicle positioning. However, body surface positioning is only used as an intraoperative, and X-ray monitoring is still good during surgery.
5730 Led Chip,5730 Red Led Chips,White Smd Led Chips,Led Diode Lights Chip
Shenzhen Huangtai Photoelectric Co.,Ltd. , https://www.huangtailed.com