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《The Journal of Traditional Chinese Orthopedics and Traumatology》 2017-02
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Study on the safety and stability of upper-middle thoracic pedicle screw insertion through pedicle rib unit approach

SHENG Hongfeng;XU Weixing;LU Di;DING Weiguo;XU Xinwei;Tongde hospital of Zhejiang province;  
Objective:To explore the safety and stability of upper- middle thoracic pedicle screw insertion through pedicle rib unit(PRU) approach.Methods:Ten volunteers with no spinal disease received CT scanning at T_(1-8) vertebral segments,and safe angle range of pedicle screw insertion through PRU approach,transverse diameter of pedicle of vertebral arch,transverse diameter of PRU,longitudinal diameter of pedicle of vertebral arch,longitudinal diameter of PRU and PRU overlapped longitudinal diameter of all segments were measured on the obtained CT images.Four cadaveric T_(1-8) specimens were selected and 10 cm long ribs were reserved.The pedicle screws were randomly inserted into both sides of each spine specimen through classical pedicle of vertebral arch approach and PRU approach respectively.The diameters of the screws were 70%of transverse diameter of corresponding pedicles of vertebral arch and the lengths of the screws were70%of the maximal values of corresponding screw path lengths.The pull- out strength of the screws were measured by using instron 5569 electronic universal testing machine.Results:The safe angle ranges of pedicle screw insertion through PRU approach were 19.71 +/- 1.64,19.42 +/-1.88,17.17 +/-0.67,17.22 +/-1.17,19.36 +/-1.31,18.67 +/-1.58,18.82 +/-2.60,18.72 +/-1.58 degrees respectively at T1- 8 vertebral segments of 10 volunteers.The transverse diameters of pedicle of vertebral arch were less than the transverse diameter of PRU at T_(1-8) vertebral segments of the 10 volunteers(8.78 +/-0.05 vs 18.23 +/-2.46 mm;t=18.192,P = 0.013;7.59 +/-0.08 vs16.80 +/-1.31 mm,t=20.175,P =0.002;6.29+/-0.07 vs 15.12 +/-1.22 mm,t=20.271,P =0.004;5.50+/-0.05 vs 14.43 +/-1.00 mm,t=21.403,P=0.004;5.52 +/-0.06 vs 14.02 +/-0.85 mm,t=20.312,P = 0.001;5.90 +/-0.06 vs 14.19 +/-1.12 mm,t=16.112,P=0.041;6.31 +/-0.07 vs 14.77+/-1.31 mm,t =14.229 P =0.017;6.64 +/-0.03 vs 15.53+/-1.90 mm,t= 13.000,P =0.048).In general,there was statistical difference between longitudinal diameter of pedicle of vertebral arch,longitudinal diameter of PRU and PRU overlapped longitudinal diameter at T_(1-8) vertebral segments of the 10 volunteers(8.04 +/- 1.01,11.05 +/- 1.83 6.37 +/-0.68 mm,F =236.422,P = 0.000;10.72 +/-0.99,13.09 +/-1.30,7.46 +/-1.12 mm,F = 60.570,P = 0.000;11.34 +/-0.99,13.45 +/- 0.92,8- 99 +/- 0.62 mm,F = 67.560,P =0.000;10.67 +/- 0.91,12.49 +/- 0.94,7.94 +/- 0.84 mm,F = 64.965,P =0.000;10.34 +/-0.94,11.96 +/- 0.95,7.96 +/- 0.96 mm,F = 44.926,P = 0.000;11.33 +/- 0.96,12.36 +/- 0.62,7.72 +/-0.88 mm,F= 85.197,P =0.000;11.30 +/-0.82,12.16 +/-0.71,8.34 +/-0.47 mm,F = 92.350,P =0.000;11.39 +/-0.78,13.71 +/-1.51 9.34 +/-0.93 mm,F = 37.867,P=0.000).The longitudinal diameter of pedicle of vertebral arch and the longitudinal diameter of PRU were larger than PRU overlapped longitudinal diameter of the 10 volunteers at Tl- 8 vertebral segments(P = 0.004 P =0.003,P=0.001 P=0.002,P= 0.013,P=0.030,P=0.025,P = 0.001;P =0.000,P=0.000,P=0.000,P=0.000,P=0.000 P=0.000,P = 0.000,P = 0.000),and the longitudinal diameter of pedicle of vertebral arch was less than longitudinal diameter of PRU(P =0.000,P = 0.000,P = 0.000 P=0.000 P= 0.000 P = 0.000,P = 0.000,P=0.000).The pull- out strengths of the screws inserted through the pedicle of vertebral arch approach were greater than those through PRU approach at T_(1-8) vertebral segments(663.60 +/-22,13 vs 470.33+/-33.09 N,t=27.876,P = 0.000;702.82 +/-24.23 vs 531.76+/-13.53 N,t= 38.402,P =0.000;713.58 +/-37.90 vs544.98+/-14.22 N,t =37.518,P =0.000;700.70 +/- 35.66 vs 590.80+/-24.72 N,t = 10.512,P = 0.000;805.28 +/-64.67 vs591.50+/-62.55 N,t = 19.546,P =0.000;808.68 +/-42.84 vs 629.08 +/-43.09 N,t = 19.436,P = 0.000;864.62 +/-35.49 vs591.60+/-52.91 N,t=24.350 P =0.000;909.18 +/-46.05 vs 640.70+/-21.41 N,t= 15.162,P = 0.000).Conclusion:PRU approach surpasses pedicle of vertebral arch approach in the safety of upper- middle thoracic pedicle screw insertion.however,the latter surpasses the former in the stability of inserted screws.
【Fund】: 全国名老中医药专家传承工作室建设项目[国中医药人教发2014(20)号]
【CateGory Index】: R687.3
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