个体化导板与计算机导航系统辅助经皮椎弓根螺钉置钉治疗胸腰段骨折比较

Comparison of minimally invasive pedicle screw placement in thoracic-lumbar fractures with extracorporeal individualized guide plate combined with fluoroscopy and computer navigation system

中文关键词:  胸腰椎  骨折内固定术  微创外科手术  3D打印技术

英文关键词:Thoracic-lumbar  Internal fixation of fracture  Minimally invasive surgery  3D printing technology

中文摘要:

  【摘要】 目的：探讨结合透视的皮外个体化导板辅助置入经皮椎弓根螺钉治疗胸腰段骨折的可行性及临床疗效。方法：回顾性分析2014年2月～2015年4月我院收治的53例胸腰段骨折手术患者资料。其中，22例应用结合透视的皮外个体化导板辅助置入经皮椎弓根螺钉（观察组），31例采用二维计算机导航辅助置入经皮椎弓根螺钉（对照组）。记录两组患者术中出血量、手术时间、术中透射次数、切口长度、螺钉与椎弓根皮质的解剖位置关系、首次穿刺成功率、矢状面螺钉置入角，测量术前模拟置入的标准微创定位导针和术后实际螺钉内倾角，对以上参数进行统计学分析。结果：所有患者均顺利完成手术，共置入椎弓根螺钉318枚，其中观察组132枚，对照组186枚；无重要血管及神经损伤。平均随访时间12.7±3.4个月，观察组和对照组术中出血量分别为53.2±7.6ml、56.0±9.9ml，术中摄片总次数分别为11.1±2.7次、9.8±3.0次，差异无统计意义（P＞0.05）。观察组和对照组手术时间分别为69.9±12.5min、108.8±25.9min，切口总长度分别为9.2±1.8cm、12.5±3.8cm，差异有统计学意义（P＜0.05）。观察组和对照组螺钉与椎弓根皮质的关系，Ⅰ级分别为124、154枚，首次穿刺成功率分别为90.1%、81.7%，两组间螺钉与椎弓根皮质的关系和第一次穿刺成功率的差异均有统计学意义（P＜0.05）。矢状面螺钉置入角分别为2.8°±2.1°、2.6°±1.9°，两组间差异无统计学意义（P＞0.05）。观察组中，左、右侧术后钉道相对于术前模拟之标准定位导针的内倾角偏差值，均无统计学差异（P＞0.05）。结论：结合透视的皮外个体化导板相对于二维计算机导航系统辅助经皮椎弓根螺钉的置入，在同样透视次数下，减少了手术时间、获得了更好的置钉准确率。

英文摘要:

  【Abstract】 Objectives: To explore the feasibility and clinical effect of minimally invasive pedicle screw placement in the treatment of thoracic-lumbar fracture with the help of extracorporeal individualized guide plate combined with fluoroscopy. Methods: From February 2014 to April 2015, 53 cases of thoracic-lumbar fracture admitted to our hospital were retrospectively analyzed. Among them, extracorporeal individual guide plate combined with fluoroscopy were applied in 22 cases to assist minimally invasive pedicle screw insert(observation group), computer navigation system aided minimally invasive pedicle screw placement were allpied in 31 cases(control group). Blood loss, operation time, number of intra-operative X-ray exposures, incision length, anatomical location of screw and pedicle cortex, success rate of first puncture and sagittal screw insertion angle were recorded. The inclined angle deviation of postoperative screw and preoperative simulated screw were measured and calculated. All above parameters were statistically analyzed. Results: All patients were operated successfully. A total of 318 pedicle screws was implanted, including 132 in the observation group and 186 in the control group. No significant vascular or nerve injury happened. The average follow-up was 12.7±3.4 months in all patients. Bleeding of observation group and control group was 53.2±7.6ml and 56.0±9.9ml respectively, and the number of intra-operative X-ray exposures was 11.1±2.7 and 9.8±3.0 respectively, without statistical difference(P＞0.05). The operation time in the observation group and the control group was 69.9±12.5min and 108.8±25.9min respectively, the incision length was 9.2±1.8cm and 12.5±3.8cm respectively, with statistically significant differences(P＜0.05). In the observation group and control group, the relation between screw and pedicle cortex was 124 and 154 respectively in grade I, the success rate of the first puncture was 90.1% and 81.7% respectively, with statistically significant differences(P＜0.05). Sagittal screw insertion Angle was 2.6±2.1° and 2.6±1.9° respectively, without statistically significant differences. In the observation group, there was no significant difference in the Angle between the postoperative nailing and preoperative simulated nailing. Conclusions: Compared with computer navigation system, the extracorporeal individualized guide plate combined with fluoroscopy aided minimally invasive pedicle screw placement can reduce the operation time and obtain the accurate nail placement without significantly increasing fluoroscopy.