自制框型术前胸腰椎椎弓根定位器的设计与应用  

Design and application of self-made preoperative frame thoracolumbar spine pedicle locator for location

作　　者：郝帅[1] 马迅[1] 陈晨[1] 邢泽军[1] 关晓明[1] 

机构地区：[1]山西医科大学附属大医院骨科,太原030001

出　　处：《山西医科大学学报》2017年第2期184-187,共4页Journal of Shanxi Medical University

摘　　要：目的评估自制框型术前胸腰椎椎弓根定位器在减少术前定位X线透视次数、缩短术前定位时间以及提高定位准确性方面相较于克氏针定位法的优势。方法自2016-03~2016-08共70例患者行胸腰椎微创手术,其中行胸腰椎椎体压缩性骨折椎体后凸成形术(PKP术)42例,行腰椎通道下经椎间孔椎间融合术(MIS-TLIF)联合经皮椎弓根钉椎体内固定术28例,所有患者均进行术前定位,按照定位方法不同分为定位器定位组和克氏针定位组。定位器定位法组患者40例(行PKP术25例,行MIS-TLIF术18例),克氏针定位法组患者30例(行PKP术17例,行MIS-TLIF术13例)。两组患者性别、年龄、病程及手术节段的差异无统计学意义,所有患者每次透视时间均为1 s,体表皮肤标记笔划线后常规消毒铺单,在标记点插入长针头后透视,评价定位准确性,对两组患者定位透视次数、定位时间和定位准确性进行比较分析。结果定位器定位组和克氏针定位组患者定位透视准确率分别为87.5%和85.0%,差异无统计学意义(P>0.05)。定位器定位组和克氏针定位组术前定位时间分别为(124.4±9.4)s、(240.0±22.9)s,定位透视次数分别为1.3±0.5次和5.0±1.2次。两组间各节段术前定位时间、定位透视次数差异有统计学意义(P<0.05)。结论自制框型微创腰椎术前椎弓根定位器定位法可以获得和克氏针定位法相同的定位准确率,但前者具有操作简便、术者及患者接受X线透视次数少的优点。Objective To estimate the advantages of the location by self-made preoperative frame pedicle locator superior to Kirschner wire. Methods Seventy patients underwent minimally invasive surgery from March 2016 to August 2016, including 42 patients with percutaneous kyphonplasty and 28 patients with minimally invasive surgery transforaminal interbody fusion combined with percutaneous pedicle screw fixation. Forty patients were treated with self-made preoperative frame pediele locator, and 30 patients underwent conven- tional methods of Kirschner wire locating. There was no significant difference in the gender, age and fusion level between two groups. Every shot time of X-rays rediation for all patients was one second. Regular disinfection and draping was done after skin marking, and then its accuracy was estimated after a long needle was inserted at the marking point. The preoperative positioning time, positioning fre- quency and rate of accurancy were compared and statistically analyzed. Results The accurancy was 87.5% and 85.0% in self-made locator group and Kirschner wire group, respectively（ P 〉 0.05 ）. The preoperative positioning time in self-made locator group and kir- schner wire group was （ 124.4 ± 9.4） s and （ 240.0 ± 22.9 ） s respectively. The positioning frequencies were 1.3 ± 0.5 times and 5.0 ± 1.2 times in self-made locator group and Kirschner wire group respectively. There was statistical difference in preoperative positio- ning time and positioning frequency between two groups （P 〈 0.05）. Conclusion The accuracy of two methods is similar, but the method of self-made preoperative frame pedicle locator has the advantages of easier maltipulation and less quantity of X-ray rediation than the method of Kirschner wire locating.

关 键 词：微创手术 腰椎 定位器 X线 

分 类 号：R681.5[医药卫生—骨科学]