O型臂导航系统辅助胸椎椎弓根螺钉置入的准确性及学习曲线  

The accuracy and learning curve of pedicle screw placement by using O-arm navigation in thoracic spine

作　　者：钟军[1] 温冰涛[1] 陈仲强[1] ZHONG Jun;WEN Bingtao;CHEN Zhongqiang

机构地区：[1]北京大学国际医院骨科,北京市102206

出　　处：《中国脊柱脊髓杂志》2021年第3期230-237,共8页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探究应用O型臂导航系统辅助胸椎椎弓根螺钉置入的准确性及其学习曲线。方法:回顾性分析2015年5月~2018年5月我院行胸椎内固定手术的患者临床资料109例,其中男性49例,女性60例,年龄53.5±12.3岁(27~77岁)。根据是否使用O型臂导航系统辅助置钉分为导航组(A组,n=66)和非导航组(B组,n=43),置钉过程由医师1(具有3年脊柱外科手术经验)或医师2(具有20年脊柱外科手术经验)完成。导航组医师1完成35例(A1组),医师2完成31例(A2组);非导航组医师1完成18例(B1组),医师2完成25例(B2组)。待引流管拔除后复查胸椎平扫CT,根据Neo′s法对术后椎弓根螺钉位置进行分级,统计各组的满意置钉(0级、1级螺钉)和螺钉穿透皮质(1级、2级、3级螺钉)的情况。比较各组的满意置钉率和皮质穿透率,并用皮质穿透率衡量同组内不同节段的置钉准确度。记录并比较各组的置钉时间,观察置钉时间随手术例数增加的动态变化,采用线性回归分析的方法探讨置钉时间与手术例数的关系。比较每组内不同阶段置钉时间和皮质穿透率的差异,评价术中应用O型臂导航系统的学习曲线。结果:共置入胸椎椎弓根螺钉668枚,其中,A1组置入螺钉222枚,满意置钉率97.3%,皮质穿透率10.8%;A2组置入螺钉188枚,满意置钉率97.9%,皮质穿透率10.1%;B1组置入螺钉120枚,满意置钉率91.7%;皮质穿透率20.0%;B2组置入螺钉138枚,满意置钉率97.8%,皮质穿透率9.4%。B1组的满意置钉率明显低于其他各组,且皮质穿透率也明显高于其他各组。B1组在胸椎不同节段(上胸段、中胸段、下胸段)的皮质穿透率存在显著差异(37.5%,28.6%,13.4%,P=0.02),而其余3组在胸椎不同节段的置钉准确率无统计学差异。B1组的单枚螺钉置钉时间(4.87±0.34min)明显高于其他3组(4.38±0.97min、4.40±1.00min、4.18±0.22min)。导航组(A组)的单枚螺钉置钉时间随着术者手术例数的增加而下降,线性�Objectives:This study aimed to evaluate the accuracy andlearning curveof pedicle screw place-ment by using O-arm navigation versus C-arm guidance in thoracic spine.Methods:Retrospective analysis was performed on 109 cases of thoracic spine surgery performed by Peking University International Hospital from May 2015 to May 2018,including 49 males and 60 females.The age ranged from 27 to 77 years old,with an average age of 53.5±12.3 years.These cases were divided into navigation group(group A,n=66)and non-navigation group(group B,n=43)according to whether used of O-arm navigation.35 cases of group A were completed by doctor 1 who had 3 years of experience in spinal surgery(group A1);31 of group A were completed by doctor 2 who had 20 years of experience(group A2).On the other hand,18 of group B were completed by doctor 1(group B1)and 25 of group B were completed by doctor 2(group B2).Postoperative pedicle screw position was graded according to Neo′s method,and satisfactory screw placement(grade 0+1 screws)and screw penetration into the cortex(non-grade 0 screws)in each group were compared.The cortical perforation rate at different segment in the same group were compared.The screwsetting time of each group were recorded.Linear regression analysis was used to investigate the relationship between the screw setting time and operation numbers,and compare the difference of screw settingtime and cortical perforation rate in different stages,thus,to analyze the learning curves of O-arm navigation in thoracic spine.Results:A total of 668 thoracic pedicle screws were inserted in the 4 groups,of which 222 were inserted in group A1,with a satisfactory rate of 97.3%and a cortical perforation rate of 10.8%.In group A2,188 screws were inserted,the satisfactory rate was 97.9%,and the cortical perforation rate was 10.1%.In group B1,120 screws were inserted,with a satisfactory rate of 91.7%,and cortical perforation rate 20.0%.In group B2,138 screws were inserted,with a satisfactory rate of 97.8%,and cortical perforation rate of 9.

关 键 词：胸椎椎弓根螺钉置入 O型臂导航系统 学习曲线 

分 类 号：R687.3[医药卫生—骨科学]