"O"型臂导航系统辅助半椎体切除植骨融合内固定治疗颈胸段先天性半椎体畸形  

O-arm navigation assisted hemivertebra resection and bone grafting and internal fixation for the congenital cervicothoracic hemivertebra

作　　者：邢帅[1] 高延征[1] 王红强[1] 张锴 张广泉[1] 施新革[1] 朱宇[1] Xing Shuai;Gao Yanzheng;Wang Hongqiang;Zhang Kai;Zhang Guangquan;Shi Xinge;Zhu Yu(Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中华骨科杂志》2023年第6期351-358,共8页Chinese Journal of Orthopaedics

基　　金：河南省医学科技攻关项目(LHGJ20220034);河南省医学科技攻关计划(SB201901085)

摘　　要：目的探讨"O"型臂导航系统辅助半椎体切除植骨融合内固定治疗颈胸段先天性半椎体畸形的临床疗效。方法回顾性收集2016年2月至2020年10月河南省人民医院收治的颈胸段半椎体畸形患者12例,男5例、女7例,年龄(9.4±2.6)岁(范围4~15岁)。术中采用神经监测系统确保手术矫形的安全性,采用"O"型臂导航系统辅助置入椎弓根螺钉,切除半椎体,矫形侧凸畸形。术后采用CT评估置钉准确性,术前、术后摄站立位脊柱全长正侧位X线片测量冠状面及矢状面Cobb角。末次随访时计算脊柱侧凸及后凸矫正率、内固定、双肩高度差及植骨融合情况。结果12例共置入椎弓根螺钉108枚,置钉准确率为96.3%(104/108)。随访时间(37.9±10.2)个月(范围24~61个月)。融合节段为(5.4±1.1)个(范围4~7个)。术后1周脊柱侧凸Cobb角矫正率为78.5%±3.2%,后凸Cobb角矫正率为70.1%±5.4%。术后1周及末次随访时侧凸、后凸角度及脊柱侧凸研究学会-22项问卷(Scoliosis Research Society-22,SRS-22)评分与术前比较差异均有统计学意义(P<0.05);术后1周与末次随访比较差异均无统计学意义(P>0.05)。至末次随访12例植骨均达EckⅠ级融合。术前双肩高度差(shoulder imbalance,SI)为(2.4±0.8)cm,术后1周为(1.0±0.6)cm,末次随访为(0.7±0.5)cm,差异有统计学意义(F=38.30,P<0.001)。术中及随访期间均未发生假关节形成、明显的矫正角度丢失、内固定松动及断裂。结论"O"型臂导航系统航辅助置钉矫形植骨融合固定联合半椎体切除治疗颈胸段半椎体畸形具有矫形效果好、放射暴露减少及并发症少等优点,可精准植入椎弓根螺钉和切除半椎体。Objective To investigate the clinical efficacy and precautions of O-arm combined with navigation-assisted steotomy and hemivertebra resection for congenital cervicothoracic hemivertebra.Methods From February 2016 to October 2020,the clinical data of 12 patients with cervicothoracic hemivertebra admitted in Henan Provincial People's Hospital were retrospectively analyzed,including 5 males and 7 females,aged 9.4±2.6 years(range,4-15 years).Intraoperative neural monitoring system was used to ensure the safety of surgical correction process and O-arm navigation system assisted the implantation of pedicle screws,hemivertebra resection,and scoliosis deformity correction.Postoperative CT was used to evaluate the accuracy of screw placement,and routine preoperative and postoperative X-ray films of the full-length spine in standing position were taken to measure the coronal and sagittal Cobb angles.The correction rate of scoliosis and kyphosis,internal fixation,shoulder height difference and bone graft fusion were calculated at the final follow-up.Results A total of 108 pedicle screws were inserted in 12 patients,and the screw placement accuracy rate was 96.3%(104/108).The follow-up time was 37.9±10.2 months(range,24-61 months).The number of fused segments was 5.4±1.1(range,4-7).One week after surgery,the correction rate of Cobb angle was 78.5%±3.2%for scoliosis and 70.1%±5.4%for kyphosis.There were statistically significant differences in side and kyphosis Angle and Scoliosis Research Society(SRS)-22 score between preoperative and 1 week after surgery(P<0.05).There was no significant difference between the operation and the last follow-up(P>0.05).At the last follow-up,all the 12 patients achieved gradeⅠfusion.SI was 2.4±0.8 cm before operation,1.0±0.6 cm at 1 week after operation,and 0.7±0.5 cm at last follow-up,and the difference was statistically significant(F=38.30,P<0.001).No pseudojoint formation,significant loss of correction Angle,or rupture of internal fixation relaxant occurred during the operation or

关 键 词：脊柱疾病 颈椎 胸椎 手术导航系统 

分 类 号：R726.8[医药卫生—儿科]