影像导航椎体成形术治疗胸腰段椎体爆裂骨折  

Using computer-assisted fluoroscopic navigation to guide the Treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle screw fixation

作　　者：刘恩志[1] 蔡维山[1] 郭东明[1] 徐中和[1] 

机构地区：[1]广州市第一人民医院脊柱外科,广州市盘福路1号510180

出　　处：《中国矫形外科杂志》2005年第4期245-248,共4页Orthopedic Journal of China

摘　　要：目的探讨骨科手术导航系统引导椎体成形术辅助短节段椎弓钉内固定治疗胸腰段椎体爆裂骨折应用的有效性和效果。方法对18例胸腰段椎体爆裂骨折采用导航引导下的短节段椎弓钉固定结合钙磷骨水泥灌注椎体成形术,内植完成后即做X线片正侧位摄片与导航路径进行吻合测量。结果本组患者术后内植物位置理想,椎弓钉位置评级理想68枚(94%),3枚突破椎弓根外侧皮质(4%),II级1枚。术后1周离床负重行走。椎体高度丢失恢复40%,随访12个月后显示椎体高度平均改变0.15%,过伸过屈动力摄片显示固定段无异常活动,未发现有椎弓钉松动、断裂病例。结论导航引导椎弓钉植入及钙磷骨水泥灌注椎体成形术,只需1次X线片成像就能做出虚拟的手术环境和路径;使内植物精确植入最佳位置,提高了椎弓钉植入及椎体成形手术的安全性,提高手术疗效。Objective: To explore outcomes and validity of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar fracture.Method: Eighteen patients with thoracolumbar unstable fractures treated with short-segment pedicle screw fixation by guide of the computer-assisted fluoroscopic navigation.Fractures were reinforced with CPC cement vertebroplasty.Postimplantation measurement of the implants' images-error between virtual image of fluoroscopy and X-ray image were done.Result: Excellent correlation was observed,68 screws(94 % ) were excellent,3 screws broke through lateral cortex of the pedicle,one screw was II grade.All cases were allowed sitting-up or bearing weight within one week.Twelve months later,X-ray reviewed the correction of kyphotic Cobb's angles averaged 6.4°,the height of vertebral restored 40% postoperatively.After 12 months following-up,X-ray reviewed the height of vertebral only changed 0.15%,dynamic lateral films reviewed no abnormal segment instability,and no instrument failures.Conclusion:Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle screw fixation can let the internal fixation approach to the precise position by one time of X-ray image by the guide of the visual image,it increases the security of pedicle screw fixation and vertebroplasty.

关 键 词：计算机X影像导航 胸腰椎骨折 椎弓钉 椎体成形术 钙磷骨水泥 后凸畸形 

分 类 号：R687.3[医药卫生—骨科学]