计算机导航辅助下经关节突寰枢关节螺钉治疗齿状突骨折的临床研究  

Clinical research of atlantoaxial transarticular screw fixation for odontoid fractures with computer navigation assisted system

作　　者：左灿辉[1] 王鲁博[1] 许世宏[1] 董金磊[1] 周东生[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021

出　　处：《山东大学学报（医学版）》2012年第12期103-106,117,共5页Journal of Shandong University:Health Sciences

基　　金：山东省医药卫生科技发展计划(2009年第HZ062号)

摘　　要：目的通过比较计算机导航辅助下寰枢关节螺钉置钉方法(导航组)与传统C臂透视指导下寰枢关节螺钉置钉方法(传统组)的临床疗效,评估计算机导航辅助技术在经关节突寰枢关节螺钉治疗齿状突骨折中的临床应用价值。方法对28例经关节突寰枢关节螺钉后路寰枢融合治疗齿状突骨折患者进行回顾性分析,其中导航组13例,传统组15例,比较两组患者手术时间、透视时间、出血量及术后并发症等情况,术后影像学检查评估两组患者螺钉植入的准确性。结果 28例患者共放置寰枢关节螺钉55枚。平均手术时间导航组154.9 min,传统组182.2 min,两组差异有统计学意义(P<0.01),平均透视时间导航组(41.3 s)显著少于传统组(64.3 s)(P<0.01)。术后影像学检查显示导航组螺钉位置均满意,传统组中6枚螺钉位置不满意。结论计算机导航辅助下置入寰枢关节螺钉可以提高手术的安全性和准确性,减少患者和术者射线暴露,缩短手术时间,是治疗齿状突骨折的有效方法。Objective To assess the clinical value of atlantoaxial transarticular screw fixation for odontoid fractures with computer navigation assisted system through comparing the clinical effects of atlantoaxial transarticular screw fixation by computer navigation assisted system （navigation group） with those of atlantoaxial transarticular screw fixation by C-arm fluoroscopy（historic control group）. Methods We retrospectively reviewed twentiy-eight patients diagnosed with od- ontoid fractures who underwent posterior approach atlantoaxial fusion by transarticular screw fixation. The navigation group included 13 patients and the other 15 patients were in the historic control group. Operative time, fluoroscopy time, blood loss and postoperative complications were compared between the two groups. We evaluated the screw ac- curacy through postoperative radiology examination. Results Totally 55 atlantoaxial transarticular screws were placed in the twentiy-eight patients. The mean operative time was 154.9 min in the navigation group compared with 182, 2 rain in the historic control group. There was statistical difference between the two groups（ P 〈 0.01 ）. The mean fluo- roscopy time in the navigation group was 41.3 s compared to 64.3 s in the historic control group （P 〈0.01 ）. Postop- erative radiographs showed all the screws were placed satisfactorily in the navigation group. The position of six screws in the historic control group was demonstrated suboptimal. Conclusion The computer navigation assisted system en- hanced safety and accuracy of atlantoaxial transarticular screw fixation, decreased patients and surgeons＇ radiation ex- posure and reduced operation time. This technology is an effective method for the treatment of odontoid fractures.

关 键 词：寰枢关节 螺钉固定 齿状突 骨折 计算机导航 

分 类 号：R683.2[医药卫生—骨科学]