新型脊柱定位仪在椎弓根螺钉植入手术中的应用研究  

Percutaneous lumber pedicle screw placement with the use of a novel spinal location system

作　　者：王作伟[1,2] 吴浩[2] 陈赞[2] 王兴文[2] 袁庆国[1] 菅凤增[2] 

机构地区：[1]北京医院神经外科,北京100730 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经外科疾病研究杂志》2017年第6期490-493,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(81271519);北京医院科研课题资助项目(BJ-2015-133)

摘　　要：目的设计一种新型脊柱定位仪,通过脊柱标本椎弓根穿刺验证定位仪的实用性与定位准确性。方法自行设计一种脊柱定位仪,选择4具成人脊柱尸体标本,使用脊柱定位仪对尸体标本的椎弓根进行穿刺,测量椎弓根内、外缘的穿刺点与提前计划的理想穿刺点之间的距离,根据穿刺针的最大偏差数值计算穿刺的优良率。结果共穿刺了尸体标本L_1-S_1的48个椎弓根,椎弓根外缘穿刺点与理想穿刺点的偏差距离在正位X光片上为:0~6.0 mm,平均1.8 mm;侧位X光片上为:0~7.0 mm,平均1.6 mm。椎弓根内缘穿刺点与理想穿刺点的偏差距离为在正位X光片上为:0~6.4 mm,平均2.0 mm;侧位X光片上为:0~7.3 mm,平均1.9 mm。穿刺的最大偏差距离为:0~7.3 mm,平均2.4 mm。穿刺结果,优:34例(70.8%);良:10例(20.8%);差:4例(8.3%),优良率为91.7%。结论新型脊柱定位仪在椎弓根穿刺试验中提高了穿刺的准确性,具有体积小巧、操作方便、精确性高等特点,具有较好的应用前景。Objective The aim of this study was to introduce a novel spinal location system for percntaneous pedicie screw placement and to evaluate the accuracy of puncture with the use of spinal location system in minimally invasive spine surgery （MISS）. Methods The accuracy of puncture with the use of spinal location system in 4 adult cadavers was evaluated. Forty-eight Kirschner wires were inserted into bilateral pedicle from L1 to S1 using spinal location system. The distances between the planned and actual puncture points on pedicles were measured. The excellent and good rate of Kirschner wire placement was evaluated according to the assessment standard of Richter. Results Using the spinal location system, 48 Kirschner wires were in,planted successfully and 96 puncture points were measured. The average distance between the plmmed and actual puncture points on lateral part of pedicle were 1.8 mm （X-ray anteroposterior view, A-P view） and 1.6 nma （X-ray lateral view, L view） ; the average distance on internal part of pedicle were 2.0 mm （A-P view） and 1.9 mm （L view） ; The average puncture distance deviation was 2. 4 nrn. The puncture results were excellent in 34 cases （70. 8% ）, good in 10 cases （20. 8% ）, and poor in 4 cases （8.3%）. The excellent and good rate was 91.7%. Conclusion Based on the resulting data, the novel spinal location system improves the accuracy in percutaneous spinal surgery, so it has exhibited a good technical and market prospect.

关 键 词：脊柱 定位仪 椎弓根 导航 机器人 

分 类 号：R687.3[医药卫生—骨科学]