引导通道辅助下经皮椎弓根置钉与传统经皮椎弓根置钉的比较

Guide chunnel assistance vs conventional method in placement of percutaneous pedicle screw

中文关键词:  经皮椎弓根螺钉  引导通道  定位  X线  辐射

英文关键词:Percutaneous pedicle screws  The guide chunnel  Localization  Fluoroscopy  Radiation

中文摘要:

  【摘要】 目的：比较引导通道辅助下经皮椎弓根置钉与传统透视下经皮椎弓根置钉的手术时间、射线暴露时间和置钉准确性。方法：70例无神经症状的胸腰椎骨折患者，随机分为A、B两组，A组35患者采用传统透视下经皮置入椎弓根螺钉，共置入180枚椎弓根螺钉；B组35例患者采用引导通道辅助下经皮置入椎弓根螺钉，共置入178枚椎弓根螺钉，均由同一术者完成置钉。记录两组椎弓根置钉时间、射线暴露时间，术后连续2次复查手术节段CT对两组病例置钉准确性进行评估并分级。比较两组患者单枚椎弓根螺钉置钉时间、射线暴露时间和置钉准确性。结果：两组患者年龄、体重指数、合并疾病、骨折类型、性别比例均无统计学差异（P＞0.05）。A组单枚椎弓根螺钉平均置钉时间为14.11±3.32min，B组为11.35±2.82min，两组比较差异有统计学意义（P=0.0042）。A组平均射线暴露时间为12.07±3.06s，B组为8.06±2.15s，两组比较差异有统计学意义（P=0.0031）。A组155枚（86.11%）螺钉为A级置钉，23枚螺钉（12.78%）为B级置钉，1枚螺钉（0.56%）为C级置钉，1枚螺钉（0.56%）为D级置钉；B组156枚螺钉（87.64%）为A级置钉，20枚螺钉（11.24%）为B级置钉，1枚螺钉（0.56%）为C级置钉，1枚螺钉（0.56%）为D级置钉，两组比较差异无统计学意义（P＞0.05）。结论：引导通道辅助下经皮椎弓根置钉与传统经皮椎弓根置钉具有相同的准确性，但能明显减少置钉时间及辐射暴露时间。

英文摘要:

  【Abstract】 Objectives: To compare the time and accuracy of screw placement, time of radiation exposure between guide chunnel assistance and the conventional method in placement of percutaneous pedicle screw. Methods: There were 70 thoracolumbar patients with vertebral fracture who were randomly divided into 2 groups: in group A, there was 35 patients who underwent 180 percutaneous pedicle screws placement by conventional method; in group B, there were 35 patients who underwent 178 percutaneous pedicle screws placement by guide chunnel assistance. All the 70 cases were performed by the same surgeon. The time and accuracy of pedicle screw placement, time of radiation exposure between the two groups were recorded and compared. The accuracy of pedicle screw placement was evaluated and graded according to twice consecutive postoperative CT examination. Results: There were no significant statistical differences in age, body mass index(BMI), complicating diseases, type of fracture and sex ratio between the two groups(P>0.05). The mean time of a single pedicle screw placement in group A(14.11±3.32 minutes) and that in group B(11.35±2.82 minutes) was significantly different(P=0.0042). The time of average radiation exposure was 8.06±2.15s in group B and 12.07± 3.06s in group A（P=0.0031). In group A, a total of 155 screws(86.11%) were evaluated in grade A, 23 screws(12.78%) in grade B, 1 screw(0.56%) in grade C, 1 screw(0.56%) in grade D. In group B, 156 screws(87.64%) were evaluated in grade A, 20 screws(11.24%) in grade B, 1 screw(0.56%) in grade C, 1 screw(0.56%) in grade D. There were no statistical differences in all grades between the two groups(P>0.05). Conclusions: The percutaneous pedicle screw placement with guide chunnel assistance can provide the same accuracy of screw placement as the conventional method, and it can significantly reduce the time of pedicle screw placement and time of radiation exposure.