术前CT三维重建引导胸椎弓根螺钉置入与徒手置钉的比较研究  

Comparison between CT-3D image navigation-assisted and free-hand thoracic spine pedicle screw implantation

作　　者：陈晓明[1] 宗少晖[1] 陈前芬[1] 陈源[2] 

机构地区：[1]广西医科大学第一附属医院脊柱骨病外科,广西南宁530021 [2]广西玉林市第一人民医院脊柱骨病科,广西玉林537000

出　　处：《中国现代医学杂志》2015年第18期105-109,共5页China Journal of Modern Medicine

基　　金：广西科学研究与技术开发计划项目(No:1298003-5-1)

摘　　要：目的比较徒手置钉与术前CT三维重建导航技术在胸椎弓根螺钉置入的准确性及安全性。方法广西医科大学第一附属医院40例行后路胸椎弓根钉置入术的患者,按病种随机分配为导航组和徒手置钉组,每组各20例。对比分析两组的置钉准确性、每枚螺钉的置钉时间及置钉出血量。结果 40例患者共置钉260枚,其中优良置钉239枚(91.92%)。导航组置钉优良率为96.88%(124/128),优于徒手置钉组的置钉优良率87.1%(115/132)(P<0.05),导航组每枚螺钉的平均置钉时间和置钉出血量分别为(5.87±1.34)min和(18.31±8.56)ml,徒手置钉组分别为(3.91±2.28)min和(9.18±5.99)ml。两组比较,差异有统计学意义(P<0.05)。平均每枚螺钉置钉时间和置钉出血量成正相关(r=0.767,P<0.01)。除徒手置钉组中有1例患者术后出现胸背部皮下气肿外,其余病例术后均无神经、血管及内脏相关并发症出现。结论术前CT三维重建导航技术能显著提高胸椎椎弓根螺钉置入的精确性和安全性,但置钉时间明显长于徒手置钉,导致置钉出血量增加。【Objective】To investigate the accuracy and safety of CT-3D image navigation in thoracic spine pedicle screw implantation in comparison with free-hand pedicle screw implantation. 【Methods】A total of 40 patients treated with posterior thoracic pedicle screw implantation were randomly assigned to CT-3D image navigation group（n = 20） and free-hand group（n = 20） according to disease category. Excellent and good rate of screw position,screw implantation time, bleeding amount of implantation and incidence of neurovascular damage were compared between both groups. 【Results】A total of 260 screws were inserted. The excellent and good rate of pedicle screw insertion was 91.92%（239/260）. In the navigation group, 128 pedicle screws were inserted with an excellent and good rate of 96.88%（124/128）, which was significantly higher than that of 87.1%（115/132） in the free-hand group（P 〈 0.05）. The navigation group had longer screw implantation time [（5.87 ± 1.34） min] and a larger amount of bleeding [（18.31 ± 8.56） ml] than the free-hand group [（3.91 ± 2.28） min,（9.18 ± 5.99） ml; P 〈 0.05]. The average implantation time of each screw was positively correlated with the bleeding amount（r = 0.767,P 〈 0.01）. Only one case from the free-hand group had subcutaneous emphysema after operation. No postoperative complications were found in the remaining cases. 【Conclusions】CT-3D image navigation can accurately and safely guide the thoracic pedicle screw implantation, but markedly increases bleeding amount of implantation due to longer screw implantation time.

关 键 词：术前CT三维重建导航 徒手置钉 胸椎 椎弓根螺钉 内固定 

分 类 号：R683[医药卫生—骨科学]