摘要
目的通过术后CT重组断面评价二维计算机辅助手术导航系统辅助腰椎椎弓根螺钉植入的准确性。方法 2011年2月-2013年4月,218例腰椎后路椎弓根螺钉内固定术患者被纳入研究,随机分为二维计算机辅助手术导航植钉组(导航组)95例和X线透视辅助植钉组(透视组)123例。两组患者性别、年龄及疾病类型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组患者平均每枚螺钉植入时间、出血量、术中C臂X线机透视次数以及术中植钉一次性成功率;通过术后CT记录矢状面螺钉植入角(sagittal screw angle,SSA)、椎弓根皮质与螺钉的关系以及同一椎体双侧椎弓根螺钉矢状面夹角(sagittal angle on both sides,SBA)。结果导航组植入螺钉504枚,其中植钉一次性成功432枚(85.7%),最终植钉成功472枚(93.7%);透视组植入螺钉656枚,其中植钉一次性成功474枚(72.3%),最终植钉成功563枚(85.8%);两组植钉一次性成功率及最终植钉成功率比较差异均有统计学意义(χ2=30.19,P=0.00;χ2=18.16,P=0.00)。两组平均每枚螺钉的植入时间和出血量比较差异无统计学意义(t=0.88,P=0.38;t=1.47,P=0.14);但导航组平均每枚螺钉植入透视次数(0.7±0.3)次显著低于透视组(1.5±1.0)次(t=—8.09,P=0.00)。导航组SSA和SBA分别为(3.7±0.9)、(1.7±0.8)°,均显著低于透视组的(6.0±1.7)、(3.5±1.6)°,差异有统计学意义(t=—26.92,P=0.00;t=—22.49,P=0.00)。结论二维计算机辅助手术导航系统手术引导腰椎椎弓根螺钉植钉相对于传统X线透视下辅助植钉,能使螺钉更好地平行于上终板且提高了植钉准确率。
Objective To investigate the accuracy of the two-dimension computer-aided surgery navigation system in the lumbar pedicle screw fixation on recombinant CT section after operation. Methods Between February 2011 and April 2013, 218 patients undergoing lumbar spinal pedicle screw fixation were divided into 2 groups： twodimension computer-aided surgery navigation system was used in 95 cases（the navigation group） and X-ray fluoroscopy assistant technology in 123 cases（the fluoroscopy assistant group）. There was no significant difference in age, gender, and type of disease between 2 groups（P〉0.05）. The mean operating time, blood loss volume, and fluoroscopy times, and the one-time success rate of pedicle screw implant were observed. The sagittal screw angle（SSA）, the relationship between the pedicle cortex and screw, the accuracy rate of pedicle screw, and the sagittal angle on both sides（SBA） were observed. Results A total of 504 screws were inserted in navigation group, 432（85.7%） were inserted successfully at first time and 472（85.7%） were inserted successfully at end time. A total of 656 screws were inserted in fluoroscopy assistant group, 474（72.3%） were successfully inserted at first time, and 563（85.8%） were inserted successfully at end time. There were significant differences in the one-time success rate and final success rate of pedicle screw implant between 2 groups（χ2=30.19, P=0.00; χ2=18.16, P=0.00）. There was no significant difference in the mean operating time and the blood loss volume of pedicle screw implant between 2 groups（t=0.88, P=0.38; t=1.47, P=0.14）; but the fluoroscopy times of pedicle screw implant in navigation group 0.7±0.3 were significantly less than that in fluoroscopy assistant group 1.5±1.0（t= —8.09, P=0.00）. The SSA and SBA in navigation group [（3.7±0.9）° and（1.7±0.8）°] were significantly less than those in fluoroscopy assistant group [（6.0±1.7）° and（3.5±1.6）°]（t= —26.92, P=0.00; t= —22.49, P=0.00）. Conclusion The sagittal screw angle and accuracy of pedicle screw implant can be significantly improved using the two-dimension computeraided surgery navigation system in lumbar posterior fixation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第4期452-456,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省卫生厅科学研究项目(130513)
自贡市重点科技计划资助项目(2013S01)~~
关键词
计算机辅助手术导航系统
腰椎
内固定器
Computer-aided surgery navigation system Lumbar vertebrae Internal fixators
