三维导航与传统C型臂X线机辅助经皮椎弓根螺钉内固定治疗胸腰椎骨折对比研究

Comparative study of 3D navigation system and traditional C-arm camera in the treatment of thoracolumbar fracture with percutaneous pedicle screw fixation

中文关键词:  手术三维导航系统  胸腰椎骨折  经皮椎弓根螺钉固定

英文关键词:Surgical navigation system  Thoracolumbar fracture  Percutaneous pedicle screw fixation

中文摘要:

  【摘要】 目的：比较应用三维导航与传统C型臂X线机辅助经皮椎弓根螺钉固定治疗胸腰椎骨折手术的置钉准确性与安全性。方法：我院2015年5月~2016年12月接受经皮椎弓根螺钉内固定手术的胸腰椎骨折患者53例，按置钉辅助设备的不同分为两组：传统组29例，螺钉置入在C型臂X线机辅助下完成；导航组24例，螺钉置入在三维导航系统辅助下完成。记录每例患者术前腰背痛视觉模拟评分（visual analogue scale，VAS）、单枚螺钉置入时间、穿刺针调整次数、射线暴露时间、术中出血量、术后2d腰背部痛VAS评分及术后并发症发生情况。根据术后CT来评估两组置钉情况，依据Certzbein-Robbins改良分级来比较螺钉置入的准确性和安全性，将Ⅰ类螺钉所占比例定义为准确率，Ⅰ类和Ⅱ类螺钉所占比例定义为安全率。随访期内观察围患者并发症发生情况及钉棒断裂松脱情况。结果：两组病例年龄、性别、术前腰背痛VAS评分、骨折类型及骨折椎体分布情况无统计学差异。传统组置钉准确率为76.72%（89/116），安全率为95.69%（111/116）；导航组置钉准确率为90.63%（87/96），安全率为100%（96/96）。两组患者术后均未发生神经损伤等手术并发症，无断钉断棒及螺钉松脱情况发生。导航组在术中穿刺针调整次数、术后2d腰背部痛VAS评分、置钉准确率及安全率方面较传统组有明显优势（P＜0.05），在平均螺钉置入时间、术中出血量方面与传统组无统计学差异，在术中射线暴露时间方面明显长于传统组（P＜0.05）。结论：三维导航技术能显著提高胸腰椎骨折经皮椎弓根螺钉置入的准确性和安全性，但患者会受到更长时间的射线暴露。

英文摘要:

  【Abstract】 Objectives: To compare the accuracy and safety of 3D navigation technique and traditional C-arm camera in the treatment of thoracolumbar fracture with percutaneous pedicle screw fixation. Methods: 53 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation from May 2015 to December 2016 were collected. The patients were divided into two groups: in traditional group(29 cases), traditional C-arm X-ray guidance was used to assist pedicle screw positioning; in navigation group(24 cases), pedicle screw insertion was assisted by 3D navigation system. The preoperative visual analogue scale(VAS) of low back pain, mean screw placement time, puncture needle adjustment times, radiographic exposure time, intraoperative blood loss volume, 2-day postoperative VAS score of low back pain and the occurrence of postoperative complications were recorded. The screw trajectory of the two groups of pedicle screw was evaluated according to postoperative CT, and the accuracy and safety of screw placement between the two groups was compared according to the improved classification of Certzbein-Robbins. During the follow-up period, the incidence of perioperative complications and the dissolution of screws were observed. Results: There were no significant differences in age, sex, preoperative VAS score of low back pain, type of fracture and injured vertebral body distribution between the two groups. The accuracy rate of traditional group screw placement was 76.72%(89/116), and the safety rate was 95.69%(111/116); while that in navigation group was 90.63%(87/96) and 100%(96/96) respectively. There were no complications such as nerve injury and screw dissolution or fracture in the two groups. Compared with the traditional group, the navigation group had significant advantages in the intraoperative puncture needle adjustment times, 2-day postoperative VAS score of low back pain and the accuracy and safety of screw placement(P＜0.05). There was no significant difference in the intraoperative mean screw placement time on the intraoperative blood loss volume between the two groups. And in the intraoperative radiographic exposure time, the navigation group was significantly longer than the traditional group. Conclusions: 3D navigation technique can significantly improve the accuracy and safety of percutaneous pedicle screw placement in thoracolumbar fractures, but the patient may receive longer exposure time.