O型臂导航下骨科电钻辅助经皮椎弓根螺钉复位内固定术治疗腰椎爆裂性骨折的临床效果

O-arm navigated orthopedic electric drill-assisted percutaneous pedicle screw reduction and fixation in the treatment of lumbar burst fractures

中文关键词:  经皮椎弓根螺钉  腰椎骨折  O型臂  三维导航  腰椎小关节

英文关键词:Percutaneous pedicle screw  Lumbar fracture  O-arm  Three-dimensional navigation  Lumbar facet joint

中文摘要:

  【摘要】 目的：探索在O型臂3D导航下使用骨科电钻快速置入导针建立钉道后，行经皮椎弓根螺钉复位内固定术治疗腰椎爆裂性骨折的临床效果。方法：回顾性分析2020年1月~2024年6月在我院接受O型臂3D导航和C型臂2D透视下行经皮腰椎骨折复位内固定手术的69例连续队列病例。O型臂3D导航辅助下手术又分为使用可视化骨科电钻快速置入导针组（A组）和使用微创开路器穿刺针实时可视化置入导丝组（B组），C型臂2D透视下手术患者纳入C组。A组19例患者，年龄50（42~56）岁；B组17例患者，年龄51（49~56）岁；C组33例患者，年龄54（44~56）岁。在术后腰椎CT轴状面，采用Gertzben-Robbins分类法对椎弓根螺钉精确度进行分类，并进行简化螺钉精度等级（simplified screw accuracy grade，SSA）分级，随访1~2年返院取骨折内固定物时CT评估关节突退变情况。统计三组置钉方式手术时间、置钉时间、出血量等临床手术指标；术后3d腰椎CT判定螺钉精确性，术后末次随访时行腰椎CT判定腰椎小关节退变增生情况。结果：A组手术时间（91.68±25.31min）、出血量（48.95±27.87mL）、单枚置钉时间（6.53±1.74min）明显优于B组（101.35±24.46min、25.88±79.22mL、8.59±1.54min）和C组（120.12±31.29min、140.33±80.80mL、10.48±1.48min）（P<0.05）。在置钉精确性方面，O型臂组优级（0级置钉）183枚（74.7%）、良级（Ⅰ、Ⅱ级）和差级（Ⅲ、Ⅳ级）置钉分别为55枚（21.7%）、16枚（6.3%），C组分别为114枚（57.6%）、60枚（30.3%）、24枚（12.1%），两组间存在显著性差异（P<0.05）。术后腰椎椎小关节侵犯损伤O型臂组为47例（18.5%）与C组51例（25.8%）无明显统计学差异（P>0.05），但是在排除螺钉置入过深因素后，关节突关节侵犯损伤及其末次随访时CT检查发现继发的椎小关节增生或融合方面O型臂组为28枚（11.9%）和26枚（10.2%）优于C组38枚（20.5%）和36枚（18.2%）（P<0.05）。结论：O型臂辅助3D导航下使用骨科电钻快速置入导丝行经皮椎弓根螺钉内固定术治疗腰椎爆裂性骨折较常规O型臂导航穿刺置钉方便快捷，与C型臂2D透视相比O型臂导航置钉可显著提高精确性，降低腰椎小关节突侵犯率和末次随访时继发的椎小关节退变率。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effects of percutaneous pedicle screw reduction and internal fixation for the treatment of lumbar burst fractures under O-arm 3D navigation and assisted with orthopedic electric drill in quickly inserting a guidewire. Methods: A retrospective analysis was conducted on 69 consecutive cases of patients who underwent percutaneous lumbar fracture reduction and internal fixation surgery under O-arm 3D navigation and C-arm 2D fluoroscopy from January 2020 to June 2024 in our hospital. The surgeries under O-arm 3D navigation were further divided into a group using a visualized bone drill to quickly insert the guide pin(group A) and a group using a minimally invasive opener to insert the guide wire in real-time visualization(group B). The patients underwent surgery under 2D fluoroscopy of the C-arm were included in group C. There were 19 patients in group A, aged 50(42-56) years; 17 patients in group B, aged 51(49-56) years; and 33 patients in group C, aged 54(44-56) years. The screw accuracy was classified using the Gertzben-Robbins classification method based on the postoperative lumbar CT axial plane, and graded using the Simplified Screw Accuracy(SSA) grade. During the follow-up of 1-2 years, CT was used to evaluate the joint facet degeneration when the fracture internal fixator was removed. The clinical surgical indicators such as operative time, screw insertion time, and blood loss, as well as post-operative 3d CT screw accuracy and lumbar facet joint hypertrophy and fusion(lumbar degeneration) at final follow-up were evaluated. Results: Group A had a surgical time of 91.68±25.31min, a blood loss of 48.95±27.87mL, and a single screw insertion time of 6.53±1.74min, which were significantly better than those of group B(101.35±24.46min, 25.88±79.22mL, 8.59±1.54min) and group C(120.12±31.29min, 140.33±80.80mL, 10.48±1.48min) (P<0.05). In terms of screw placement accuracy, in O-arm group, 183(74.7%) were excellent (0-level screw placement), 55(21.7%) and 16(6.3%) were good(Ⅰ, Ⅱ levels) and poor (Ⅲ, Ⅳ levels), while in group C, it was 114(57.6%), 60(30.3%), and 24(12.1%), and there was a significant statistical difference between the two groups(P<0.05). There was no significant statistical difference in lumbar facet joint injury between the O-arm group and the C-arm group(47 cases, 18.5% vs 51 cases, 25.8%), but after excluding the factor of deep screw placement, the joint facet joint injury and the secondary lumbar facet joint degeneration found at final follow-up CT examination were 28(11.9%) and 26(10.2%) in the O-arm group, respectively, which were superior to 38(20.5%) and 36(18.2%) in the C-arm group (P<0.05). Conclusions: Using a bone drill to quickly insert the guide wire under O-arm 3D navigation for percutaneous pedicle screw internal fixation of lumbar burst fractures is more convenient and faster than conventional O-arm navigated puncture and screw insertion. Compared with the C-arm 2D fluroscopy, O-arm 3D navigation has significantly higher screw accuracy, lower facet joint injury rate and rate of secondary facet joint degeneration at final follow-up.