{"title":"利用超声波骨钻辅助改进 C1 椎弓根螺钉植入术治疗寰枢椎失稳","authors":"Changjiang Ou,Yongjun Tong,Junhui Liu,Zhi Shan,Yilei Chen,Bao Huang,Xuyang Zhang,Yili Chen,Fengdong Zhao","doi":"10.1016/j.wneu.2024.09.037","DOIUrl":null,"url":null,"abstract":"OBJECTIVE\r\nThis study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.\r\n\r\nMETHODS\r\nA retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.\r\n\r\nRESULTS\r\n13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).\r\n\r\nCONCLUSIONS\r\nUBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving C1 Pedicle Screw Placement for Atlantoaxial Instability with Ultrasonic Bone Burr Assistance.\",\"authors\":\"Changjiang Ou,Yongjun Tong,Junhui Liu,Zhi Shan,Yilei Chen,Bao Huang,Xuyang Zhang,Yili Chen,Fengdong Zhao\",\"doi\":\"10.1016/j.wneu.2024.09.037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE\\r\\nThis study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.\\r\\n\\r\\nMETHODS\\r\\nA retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.\\r\\n\\r\\nRESULTS\\r\\n13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).\\r\\n\\r\\nCONCLUSIONS\\r\\nUBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.09.037\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.09.037","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Improving C1 Pedicle Screw Placement for Atlantoaxial Instability with Ultrasonic Bone Burr Assistance.
OBJECTIVE
This study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.
METHODS
A retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.
RESULTS
13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).
CONCLUSIONS
UBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS