三维导航与普通透视下置入寰椎侧块和枢椎椎弓根螺钉治疗寰枢椎不稳的比较  

Isocentric C-arm 3D navigation versus conventional C-arm fluoroscopy for placement of CI lateralmass and C2 pedicle screws in treatment of atlantoaxial instability

作　　者：许世宏[1] 杨永良[1] 周东生[1] 何吉亮[1] 穆卫东[1] 王甫[1] 

机构地区：[1]山东大学附属省立医院、山东省骨科医院创伤骨科,济南250021

出　　处：《中华创伤骨科杂志》2012年第12期1059-1064,共6页Chinese Journal of Orthopaedic Trauma

基　　金：山东省医药卫生科技发展计划（2009年第HZ062号）

摘　　要：目的比较等中心C型臂（Iso-C）三维导航与普通透视下辅助下置人寰椎侧块和枢椎椎弓根（C1LM-C2P）螺钉的准确性。方法对2006年6月至2011年6月采用C1LM-C2P螺钉内固定治疗的30例寰枢椎小稳患者资料进行回顾性研究，男16例，女14例；年龄39～52岁，平均45．6岁、，根据术中辅助影像技术的不同分为Iso-C三维导航组（导航组，14例）和普通透视组（透视组，16例）。两组患者术前一般资料比较差肆均无统计学意义（P〉0．05），具有可比性。记录并比较两组患者的于术时间、透视时间、术中失血量、置钉准确率和日本骨科协会评分（JOA）。结果导航组和透视组置人C1LM-C2P螺钉的平均手术时间分别为（132．1±6．4）min和（143．2±8．2）min，差异尤统计学意义（仁1．761．P=0．093）。导航组术中平均透视时间（46．84±1．4）s较透视组（65．24±2．9）s明显减少，导航组平均术中失血量（305．64±50．8）mL较透视组（472．4±56．1）mL明显减少，导航组和透视组分别有94．6％和82．8％的螺钉评为0级，以上指标两组比较差异均有统计学意义（P〈0．05）。所有患者术后平均随访12．4个月，术后6个月颈椎X线片示骨折愈合。术后6个月导航组和透视组平均JOA评分分别为（15．2±0．2）分和（15．3±0．3）分，差异无统计学意义（P=0．756）；但较术前[（9．1±1．1）分]明显改善，差异均有统计学意义（P〈0．05）。结论采用ClLM-C2P螺钉治疗寰枢椎不稳时，术中采用Iso-C三维导航比普通透视能显著提高螺钉置人的准确性，并能显著减少术中透视时间及术中出血量。Objective To compare the isocentric C-arm 3-dimensional （lso-C 3D） navigation versus conventional C-arm fluoroscopy in terms of accuracy of placing CI lateral mass and C2 pedicle （C1LM-C2P） screws in the treatment of atlantoaxial instability. Methods Thirty patients with atlantoaxial instability were treated with fixation with CI I,M-C2P screws in our hospital from June 2006 to June 201 I. They were 16 men and 14 women, aged frnm 39 to 52 years （average, 45.6 years）. The Iso-C 3D navigation group had 14 patients and there were 16 patients in the conventional fluoroscopy group. The 2 groups were comparable in general clinical data （ P 〉 0.05） . The operation time, radiation time, intraoperative blood loss, insertion accuracy and Japanese Orthopaedic Association （JOA） score were recorded and compared between the 2 groups. Results There were no significant differences between the 2 groups in the mean operation time （132. 1 ±6.4 minutes versus 143.2 ±8.2 minutes） （ t = 1. 761, P =0. 093） . The mean radiation time for the lso-C 3D navigation group （46.8 ± 1.4 seconds） was significantly shorter than for the conventional fluo- roscopy group （65.2±2.9 seeomts）, the mean blood loss for the navigation group （305.6 ±50.8 mL） was significantly less than for the fluoroscopy group （472.4± 56. 1 mL）, the percentage of screws of grade 0 forthe navigation group （94. 6% ） was significantly higher than for the fluoroscopy group （82.8%） （ P 〈 0. 05 ） . The mean follow-up of 12.4 months revealed fracture union on cervical X-ray films 6 months post- operation. There were no significant differences between the 2 groups in the mean JOA score 6 months post- operation （15.2± 0. 2 points versus 15.3 ± 0. 3 points）, but there were significant differences between the preoperative and postoperative scores in the 2 groups （ P 〈 0.05）. Conclusion In the treatment of at- lantoaxial instability with fixation with C1LM-C2P screws, compared with conventional C-ann fluoros

关 键 词：寰椎 枢椎 外科手术 计算机辅助 骨钉 

分 类 号：R687.3[医药卫生—骨科学]