三维重建可视化系统可增强下颈椎椎弓根钉置入的准确性  

Three-dimensional reconstruction visualization system enhances the accuracy of lower cervical pedicle screw implantation

作　　者：刘博[1] 孙永强[2] 王同明[1] 杨中杰[1] 史大鹏[3] 

机构地区：[1]河南省中医院放射科,河南省郑州市450002 [2]河南省中医院骨科,河南省郑州市450002 [3]河南省人民医院医学影像中心,河南省郑州市450002

出　　处：《中国组织工程研究》2016年第17期2519-2525,共7页Chinese Journal of Tissue Engineering Research

基　　金：河南省科技攻关计划项目(132102310159)~~

摘　　要：背景:椎弓根钉置入是多种下颈椎疾病修复的一种常用方法。用三维重建可视化系统可以提高置钉的准确性,有利于改善患者的预后。目的:探讨下颈椎椎弓根钉置入过程中应用三维重建可视化系统对置钉准确性的影响。方法:回顾性分析89例创伤后颈椎脱位均接受下颈椎椎弓根钉置入治疗的患者,按照导航方式分为2组,对照组46例予以C臂X射线透视二维导航,观察组43例予以三维重建可视化系统导航。观察两组术中置钉时间,评价置钉准确率。置钉后随访12个月,记录不良事件发生情况,并进行比较。结果与结论:1术中置钉时间:观察组时间短于对照组,但经比较差异无显著性意义(P>0.05);2置钉准确率:观察组无三类置钉病例,置钉准确率为93%(40/43);对照组有2例为三类置钉病例,置钉准确率为81%(37/46),经比较观察组的置钉准确率显著高于对照组(P<0.05);3术后随访:所有患者均未出现神经组织损伤椎动脉、血管、脊髓等并发症。经X射线、CT复查,两组置入的螺钉均处于稳定状态,未出现断钉和松动等不良事件;4结果表明:在下颈椎椎弓根钉置入过程中辅助三维重建可视化系统导航可以有效提高置钉的准确率,且不会增加术中置钉时间或者导致各种术后不良事件的出现,是一种安全有效的导航方式。BACKGROUND：Pedicle screw implantation is a common method to repair many kinds of diseases of the lower cervical spine.Three-dimensional（3D） reconstruction visualization system can be used in order to improve the accuracy of the implant and improve the prognosis.OBJECTIVE：To investigate the effect of 3D reconstruction visualization system on the accuracy of cervical pedicle screw implantation.METHODS：The clinical data of 89 patients with cervical spine dislocation,who underwent cervical pedicle screw implantation,were analyzed retrospectively.Patients were divided into control group（46 cases） and observation group（43 cases） according to the navigation method.Patients in the control group underwent C arm X ray two dimensional navigation.Patients in the observation group underwent three-dimensional reconstruction visualization system navigation.Intraoperative placement time was observed,and the accuracy of screw placement was assessed in both groups.The cases were followed up for 12 months,and the adverse events were recorded and compared.RESULTS AND CONCLUSION：（1） Intraoperative implantation time was shorter in the observation group than in the control group,but no significant difference was found（P〉0.05）.（2） Accuracy rate：There were no three types of nail cases in the observation group,and the accuracy rate was 93%（40/43）.In the control group,two cases affected three types of nailing,and the accuracy rate was 81%（37/46）.The accuracy rate was significantly higher in the observation group than in the control group（P〈0.05）.（3） Postoperative follow-up：None suffered from nerve tissue injury to vertebral artery,blood vessel and spinal cord.The screws of the two groups were in stable condition,without screw breakage or loosening.（4） Results suggested that in lower cervical pedicle nail implantation,3D reconstruction navigation system can effectively improve the accuracy of screw placement,and does not increase nailing time or lead to adverse events.It is a safe

关 键 词：颈椎 脱位 骨钉 随访研究 组织工程 骨科植入物 脊柱植入物 三维重建 可视化系统 下颈椎 椎弓根钉置入术 外科手术 图像引导 准确性 

分 类 号：R318[医药卫生—生物医学工程]