脊柱畸形手术术中CT导航与徒手椎弓根置钉准确性比较  

Comparison of intraoperative CT-based navigation versus non-navigated pedicle screw placement in surgical correction of spinal deformity

作　　者：王铀[1] 崔赓[1] 张永刚[1] 任宁涛 张恒[1] 齐鹏[1] 董天祥[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《解放军医学院学报》2015年第6期595-598,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的通过与徒手置钉的比较,探讨在后路全椎弓根钉治疗脊柱畸形手术术中CT导航下置钉的准确性优势及临床价值。方法回顾性分析2009-2012年我科连续100例接受脊柱矫形手术并行术中CT的患者。所有病例分为导航组和非导航组,其中导航组37例,非导航组63例。根据椎弓根钉置入节段的不同,将两组各分为胸椎、上胸椎、中胸椎、下胸椎及腰椎5个亚组,比较并分析两组整体间及各亚组间椎弓根螺钉的置钉准确性。结果导航组总体椎弓根置钉准确率(94.61%)高于非导航组(88.43%)(P<0.05),返修率(2.43%)低于非导航组(6.06%)(P<0.05);各亚组间比较,导航胸椎组、中胸椎组、下胸椎组椎弓根置钉准确率均高于非导航相对应组(P<0.05),返修率均低于非导航相对应组(P<0.05);两组上胸椎组间及腰椎组间准确率及返修率差异均无统计学意义。结论术中CT导航可提高脊柱畸形矫形手术中的椎弓根螺钉置钉准确性,尤其是胸椎弓根置钉的准确性。Objective To explore the results and clinical value of intraoperative computed tomography （iCT） navigation in pedicle screw insertion accuracy in comparison to screw placement without navigation in spinal deformity surgery. Methods Clinical data about 100 patients who underwent surgical deformity correction with assistance of iCT in our hospital from 2009 to 2012 were retrospectively analyzed. All patients were divided into two groups： navigation group （n=37）, and non-navigation group （n=63）. In each group, patients were divided into different subgroups according to the spinal segment （thoracic vertebrae, upper/middle/ lower thoracic vertebrae, lumbar vertebrae）. The screw placement accuracy was analyzed. Results Compared with non-navigation group, there showed a higher accuracy rate and a lower revision rate of total pedicle screws placement in navigation group （94.61% vs 88.43%, 2.43% vs 6.06%, P 〈 0.05）. The screws insertion accuracy rate of thoracic pedicle screws, middle and lower thoracic screws in navigation group was higher and the revision rate was lower than that of non-navigation group. However, no significant difference was found in upper thoracic and lumbar pedicle screws （P 〈 0.05）. Conclusion The iCT navigation system provides a high accuracy of pedicle screw placement in surgical correction of spinal deformity, especially in thoracic spinal instrumentation.

关 键 词：术中CT 导航 椎弓根螺钉 脊柱畸形 

分 类 号：R687.3[医药卫生—骨科学]