术中三维影像脊柱导航引导半椎体切除及椎弓根螺钉置入矫治儿童先天性脊柱侧后凸畸形

Posterior pedicle screw placement and hemivertebra resection by using intraoperative 3D image spinal navigation for the treatment of children congenital kyphoscoliosis

中文关键词:  计算机辅助  儿童先天性脊柱侧后凸  截骨术  椎弓根螺钉固定

英文关键词:Computer assistance  Osteotomy  Congenital kyphoscoliosis  Pedicle fixation

中文摘要:

  【摘要】 目的：探讨术中实时三维影像脊柱导航引导下后路椎弓根螺钉置入及半椎体切除矫治儿童先天性脊柱侧后凸畸形的临床疗效。方法：自2010年5月～2013年4月，对18例儿童先天性半椎体脊柱侧后凸畸形患者进行术中实时三维影像脊柱导航引导下进行脊柱矫形手术。其中，男7例，女11例，年龄7.6±2.9岁。术中在实时三维影像脊柱导航引导下经后路置入椎弓根螺钉并切除半椎体后进行矫形。术后通过CT评价椎弓根螺钉位置及半椎体切除情况，术前、术后摄脊柱正侧位X线片，评价矫形效果。结果：手术时间216±55min，术中出血量732±378ml。18例患者共置入椎弓根螺钉127枚（4～12枚/例）。术后CT证实124枚椎弓根螺钉位置准确，置钉准确率97.6%；1枚椎弓根螺钉穿破椎弓根内侧皮质，2枚椎弓根螺钉穿破椎弓根外侧皮质。1例出现椎弓根螺钉切割，1例出现血气胸，置入胸腔闭式引流。无神经损伤并发症病例，无螺钉误置而引起的并发症。术后CT证实18例患者半椎体均完整切除。18例中有16例获得随访，随访时间18.5±8.0个月。16例术前测量冠状面节段性侧凸Cobb角44.5°±11.4°，术后为9.3°±4.7°，末次随访时为9.7°±5.0°，矫正率为（78.2±7.8）%。节段性后凸Cobb角术前测量为32.2°±7.3°，术后为7.2°±3.5°，末次随访节时为7.7°±3.9°，矫正率为（76±9.4）%。侧凸及后凸矫正与术前相比均有统计学意义（P＜0.01）。末次随访时16例患者均获得骨性融合。结论：术中实时三维影像脊柱导航引导经后路矫治先天性脊柱侧后凸畸形半椎体切除完整，置入椎弓根螺钉准确率高，安全性高，畸形矫正效果满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical effect of posterior pedicle screw placement and hemivertebra resection guided by spinal navigation with the intraoperative three dimensional(3D) image modality. Methods: Between May 2010 and April 2013, 18 children with congenital kyphoscoliosis underwent posterior pedicle screw fixation and hemivertebra resection by using intraoperative 3D image spinal navigation. All 18 children(7 males and 11 females) aged 7.6±2.9 years were diagnosed as kyphoscoliosis caused by congenital hemivertebra. Pedicle screw insertion and hemivertebra resection were performed guided by intraoperative 3D image spinal navigation. The pedicle screw position and hemivertebra resection were assessed by CT scan and the correction of Cobb angle was assessed by X-ray films preoperatively and postoperatively. Results: The operation time was 216±55 minutes and intraoperative bleeding was 732±378ml. A total of 127 pedicle screws was placed in 18 patients(4-12). 124 screws were accurtately inserted into the pedicles assessed by postoperative CT scanning(97.6% accuracy rate). 1 and 2 screws had a perforation of the medial and lateral pedicle walls. All the hemivertebrae were completely resected. Among these 18 patients, 16 cases were followed up for 18.5±8.0 months. The preoperative mean coronal Cobb angle was 44.5°±11.4°, which compared to (9.3°±4.7°) of postoperation. The mean coronal Cobb angle of final follow-up was 9.7°±5.0° with a (78.2±7.8)% correction. In sagittal plane, the preoperative mean Cobb angle was 32.2°±7.3°, which returned to 7.2°±3.5° postoperatively. The mean sagittal Cobb angle of final follow-up was 7.7°±3.9°. The postoperative correction was (76±9.4)%. The significant difference was found in coronal and sagittal Cobb(P＜0.01). All 16 patients showed bony fusion at final follow-up. The broken of pedicle screw was found in one patient. 1 patient with Hemopneumothorax was treated with closed thoracic drainage. No instrument failure and neurological deficit were observed. Conclusions: Intraoperative 3D image-guided spinal navigation for placement of pedicle screws is of high accuracy and high safety in correcting the spinal deformity.