O型臂导航系统与X线正侧位片引导下牛腰椎椎弓根打孔的对比研究  

O-arm based navigation vs X-ray fluoroscopy in accuracy of pedicle drilling in bovine lumber spine specimens

作　　者：郭乃铭[1] 张鹤[1] 李杰[1] 黄博[1] 郑文杰[1] 周跃[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《第三军医大学学报》2013年第4期277-279,共3页Journal of Third Military Medical University

基　　金："十二五"国家科技支撑计划(2012BAI14B02)~~

摘　　要：目的对比研究O型臂导航系统与X线正侧位片引导下牛腰椎椎弓根打孔的精准性。方法对15具牛脊骨4～5个腰椎节段两侧椎弓根进行打孔,在每具标本一侧节段应用O型臂导航系统引导椎弓根打孔即导航组,另一侧相应节段应用X线正侧位片引导椎弓根打孔即放射组,两组各完成椎弓根打孔61次,共置入克氏针122枚。术中应用O型臂3D扫描模式进行扫描及三维重建,术后进行经克氏针水平的CT扫描,观察克氏针置入的精准度。结果术后CT图像显示,放射组克氏针置入Ⅰ级(完全置入椎弓根内)28枚(45.9%),Ⅱ级(穿破侧壁但未完全置于椎弓根外)24枚(39.3%),Ⅲ级(完全置于椎弓根外)9枚(14.8%)。导航组克氏针置入Ⅰ级46枚(75.4%),Ⅱ级15枚(24.6%),无Ⅲ级克氏针置入情况。两组差异显著(P<0.05)。术后O型臂图像评价克氏针置入精准度结果与术后CT评价结果差异不显著(P>0.05)。放射组打孔时间平均6.5 min,导航组打孔时间平均3.9 min,差异显著(P<0.05)。结论应用O型臂导航系统辅助,能提高椎弓根打孔的精准性、缩短手术时间。Objective To evaluate the feasibility and accuracy of bovine lumber spine pedicle drilling assisted by X-ray fluoroscopy and O-arm based navigation system. Methods Sixty-one holes were drilled assisted by X-ray fluoroscopy at one side of pedicles in 4 to 5 lumbar segments from 15 bovine lumber spine specimens, and another 61 holes were drilled assisted by O-arm based navigation system at the other side. Then 122 K-wires were put into the holes in all. K-wire positions were evaluated by O-arm 3 dimensional reconstruction after intraoperative cone beam computed tomography scanning （CBCT） and postoperative CT scanning. Results Postoperative CT scanning revealed that there were 28 （45.9%） K-wires in Grade Ⅰ （perfect within the pedicles）, 24 （39. 3% ） Grade /Ⅰ （breaching the pedicle wall but not completely outside the pedicle boundaries）, and 9（ 14.8% ） Grade Ⅲ （completely outside the pedicle boundaries） in fluoroscopy group, and 46（75.4% ） in Grade Ⅰ , 15（24.6% ） in Grade Ⅱ , and none in Grade Ⅲ in O-arm group. The 2 groups had significantly difference in accuracy （P 〈 0. 05 ）. There was no significant difference in the accuracy between the assessment of intraoperative O-arm scanning and postoperative CT scanning （P 〉 0. 05 ）. Average hole drilling time was 6. 5 min （ ranging from 5.2 to 8.1 rain） in fluoroscopy group and 3.9 min （ranging from 2.8 to 5.2 min） in O-arm group （P 〈 O. 05 ）. Conclusion O-arm based navigation system increases the accuracy of pedicle drilling and reduces the surgical time significantly.

关 键 词：计算机辅助手术 O型臂 椎弓根 对比研究 

分 类 号：R197.39[医药卫生—卫生事业管理] R615[医药卫生—公共卫生与预防医学]