三维CT导航辅助椎弓根螺钉植入加半椎体切除治疗先天性脊柱侧弯57例  

SURGERY TREATMENT OF CONGENITAL SCOLIOSIS ASSISTED BY 3D-CT NAVIGATION

作　　者：陈晓明[1] 廖军[1] 刘云[1] 陈前芬[1] 

机构地区：[1]广西医科大学第一附属医院脊柱骨病外科,南宁530021

出　　处：《广西医科大学学报》2016年第2期276-279,共4页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(No.2012GXNSFAA053134)

摘　　要：目的：探讨三维CT导航辅助椎弓根螺钉植入加半椎体切除治疗先天性脊柱侧弯的安全性和临床疗效。方法：选择2009年至2015年在广西医科大学第一附属医院脊柱骨病科进行手术治疗的先天性脊柱侧弯患者57例,在三维CT导航辅助下行后路半椎体切除及钉棒系统矫形术。术中行C臂透视检查螺钉位置准确性,记录手术时间、每枚螺钉平均置钉时间,测量手术前后Cobb’s角,术后3d行置钉节段三维CT扫描评估置钉准确率。结果：共植入椎弓根螺钉408枚,其中375枚为Ⅰ级螺钉（准确率92%）。平均手术时间为190min（150～210min）,平均每枚螺钉置钉时间4.8min（3.2～9min）。术中平均总出血量550mL（350～1 200mL）。术后Cobb’s角平均矫正角度38.2°（15.2～47°）,矫正率平均为67.6%（40%～72%）。48例获得随访,随访时间平均为18.5个月（12～60个月）,无内固定物移位、断裂等并发症以及神经血管损伤发生。结论：三维CT导航技术能为先天性脊柱侧弯矫形手术提供立体实时解剖信息,以便制定最优手术计划,使置钉更加准确安全,从而提高矫形效果。Objective：To evaluate the clinical efficacy and safety of 3D-CT image navigation system for guiding internal fixation of pedical screw implantation and hemivertebra resection in the treatment of congenital scoliosis.Methods：From January 2009 to June 2015,57 patients with congenital scoliosis received internal fixation of pedicle screw implantation and hemivertebra resection guided by 3D-CT image navigation,including 24 males and 33 females with an average age of 13.5years.Preoperative measurement of 3D-CT reconstruction data was conducted to guide the surgery.C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation.The operation time,the mean implantation time per screw,blood loss,and Cobb＇s angles were recorded.3-day postoperative radiographs and CT examination were performed,which allowed the measurement of screw position relative to pedicle position according to Andrew classification.Results：Within 408 inserted screws,375 were grade I（accuracy 92%）.The average operation time,the mean implantation time per screw and blood loss were 190min（150to 210min）,4.8min（3.2to 9.0min）and 550mL（350to 1200mL）,respectively.The mean Cobb＇s angle decreased from 55°（35°to 82°）to 38.2°（15.2°to 47.0°）immediately after surgery.The mean correction rates of Cobb＇s angle were 67.6%（40.0%to 72.0%）.48 cases were followed up for 18.5months（12to 60months）.No complications such as fixator displacement or breakage or neurovascular injury occurred.Conclusion：CT-3Dimage navigation system provides real-time,multi-perspective,three-dimensional visualization of spinal anatomy,ensures the accuracy and safety of spinal pedicle screw implantation.

关 键 词：先天性脊柱侧弯 半椎体 三维CT 导航 椎弓根钉 

分 类 号：R682[医药卫生—骨科学]