O型臂3D导航辅助置钉技术在脊髓脊柱肿瘤术中重建脊柱稳定性的应用  

Application of 3D O-arm-navigated pedicle screw insertion in spinal stability reconstruction in patients with spinal cord and spinal column tumors

作　　者：荆林凯 孙振兴[2] 郭毅[1,2] 乌优图 师炜[1,2] 张培海[1,2] 张会芳 王国琴 王劲[2] 王贵怀[1,2] Jing Linkai;Sun Zhenxing;Guo Yi;Wu Youtu;Shi Wei;Zhang Peihai;Zhang Huifang;Wang Guoqin;Wang Jin;Wang Guihuai(Department of Neurosurgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China;School of Clinical Medicine,Tsinghua University,Beijing 100084,China)

机构地区：[1]清华大学附属北京清华长庚医院神经外科,102218 [2]清华大学临床医学院,北京100084

出　　处：《中华神经外科杂志》2019年第7期676-680,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81472817);北京清华长庚医院青年启动基金(12015C1045).

摘　　要：目的探讨O型臂(O-arm)导航辅助置钉技术对于脊髓脊柱肿瘤术中重建脊柱稳定性的应用价值。方法回顾性分析2015年10月至2017年12月于清华大学附属北京清华长庚医院神经外科治疗的29例脊髓脊柱肿瘤患者的临床资料。21例采用O-arm导航辅助置钉(A组),8例采用徒手置钉(B组)。29例患者均在置钉后行O-arm系统3D扫描,根据Gertzbein-Robbins的方法评估置钉的准确性。所有患者均行临床随访和影像学随访。结果两组的年龄、性别、体质量指数、术中出血量、术后住院时间以及术中射线量的差异均无统计学意义(均P>0.05)。A组内固定置钉的手术时间大于B组[分别为(109.7±59.9)min和(74.5±19.4)min,P=0.025]。A组共置入134枚螺钉,其中A级117枚,B级11枚,C级6枚。B组共置入45枚螺钉,其中A级34枚,B级4枚,C级6枚,D级1枚。两组置钉准确率的差异有统计学意义(A、B组分别为95.5%和84.4%,χ2=4.604,P=0.032)。两组无一例出现置钉相关的神经血管并发症。所有患者随访(7.3±5.4)个月,随访期间均未见脊柱畸形及钉棒相关的并发症。结论O-arm导航系统可明显提高脊髓脊柱肿瘤患者术中脊柱内固定置钉的准确性,从而有利于脊柱稳定性的重建。Objective To explore the advantages of O-arm-navigated pedicle screw insertion in patients with spinal column and spinal cord tumors. Methods We retrospectively enrolled 29 patients with spinal tumors who underwent pedicle placement using O-arm-based navigation (Group A, 21 cases) or freehand technique (Group B, 8 cases) at Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University from October 2015 to December 2017. Screw position was judged on the 3D O-arm images and the accuracy of screws placement was evaluated according to the Gertzbein-Robbins scale. The clinical data and neuroimaging data were collected during the follow-up. Results Age, sex, body mass index, mean blood loss, length of stay and radiation dose showed no significant difference (all P>0.05) between the 2 groups. The operation time in group A was longer than that in group B (109.7±59.9 min vs. 74.5±19.4 min, P=0.025). A total of 134 screws were inserted in Group A and 117 screws was classified as grade A, 11 as grade B and 6 as grade C. There were 45 screws inserted in group B and 34 screws were classified as grade A, 4 as grade B, 6 as grade C and 1 as grade D. The accuracy of screw inserting was significantly different between the 2 groups (group A: 95.5% and group B: 84.4%,χ2=4.604, P=0.032). No screw-related neurovascular complications occurred. Conclusion O-arm-based navigation system could markedly improve the accuracy of screw insertion and thus help reconstruct spinal stability.

关 键 词：脊髓肿瘤 脊柱肿瘤 神经导航 O型臂 脊柱内固定 

分 类 号：TP391.7[自动化与计算机技术—计算机应用技术] R738.1[自动化与计算机技术—计算机科学与技术]