PDF(Pubmed)
Abstract：
Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique. None of these techniques are recognized as the gold standard. This review compares the PS placement accuracy and misplacement-related complication rates achieved with the techniques mentioned above. It further reports PS accuracy classifications and anatomic PS misplacement risk factors. The literature suggests a higher PS placement accuracy for robotic relative to computed navigation and for the latter relative to the free-hand technique (misplacement rates: 0.4-7.2% versus 1.9-11% versus 1.5-50.7%) using variable accuracy classifications. The reported PS-misplacement-related complication rates are, however, uniformly low (0-1.4%) for every technique, while robotic and computed navigation induce a roughly fourfold increase in the patient\'s intraoperative radiation exposure relative to the free-hand technique with fluoroscopic implant positioning control. The authors, therefore, recommend dedicating robotic and computed navigation for complex deformities or revisions with altered landmarks, underline the need for a generally accepted PS accuracy classification, and advise against PS placement in grade 4 pedicles yielding higher misplacement rates (22.2-31.5%).
摘要：
使用椎弓根螺钉（PS）的后路脊柱融合术和节段脊柱器械是矫正青少年特发性脊柱侧凸的最常用方法。计算导航,机器人导航,和患者特定的钻孔模板是可用的，除了第一个描述的徒手技术。这些技术都不被认为是黄金标准。这篇综述比较了使用上述技术获得的PS放置准确性和与错位相关的并发症发生率。它进一步报告了PS准确性分类和解剖PS错位风险因素。文献表明，相对于计算导航，机器人的PS放置精度更高，而后者相对于徒手技术（错位率：0.4-7.2％对1.9-11％对1.5-50.7％）使用可变精度分类。报告的PS错位相关并发症发生率为，然而,每种技术的均匀低(0-1.4%)，而机器人和计算机导航导致患者术中辐射暴露量相对于具有荧光透视植入物定位控制的徒手技术大约增加了四倍。作者,因此,建议将机器人和计算机导航专用于复杂的畸形或带有更改地标的修订，强调需要普遍接受的PS精度分类，并建议不要在4级椎弓根中放置PS，从而产生更高的错位率（22.2-31.5％）。
