全皮质椎弓根螺钉讲解.ppt

Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory ; Introduction 前言 ;Exposure lateral to the facet joint to insert a pedicle screw requires a relatively long incision and muscle dissection, which may be related to postoperative low back pain from injury to the posteromedial branch of the nerve root crossing the facet joint and damage to the exposed and retracted back musculature. To minimize the incision and muscle dissection and thus reduce these problems, TLIF with minimally invasive pedicle screw insertion (M-TLIF) and TLIF with percutaneous pedicle screw insertion (P-TLIF) have been developed.;However, several clinical concerns, such as low back pain, learning curve, radiation exposure, and incorrect pedicle screw placement, have also been associated with M-TLIF and P-TLIF。;A new trajectory for pedicle screw insertion of pedicle screw placement, the cortical bone trajectory (CBT), was reported by Santoni et al. in 2009 and may address these problems. The new trajectory was from medial to lateral and cranial to caudal; this does not require wide exposure of the back muscle and thus reduces operative invasion compared with conventional or percutaneous pedicle screw insertion.;However, the differences in operative invasion, accuracy of pedicle screw insertion, and postoperative fusion rate between TLIF with CBT (CBT-TLIF) and other methods of pedicle screw placement, such as M-TLIF and P-TLIF, remain unknown. In this study, we compared the clinical and radiological results of CBT-TLIF with those of M-TLIF and P-TLIF.;Surgical procedures ;Open conventional pedicle screws were placed using the Expedium Spine System (DePuy Spine) through a bilateral Wiltse approach. Under fluoroscopic guidance in a perfect posteroanterior projection, a pedicle probe was introduced into the pedicle at a 30° medial angle and the pedicle was tapped for a screw, taking care not to p