导航辅助下颈椎前路椎弓根置钉技术的临床应用  

Clinical application of navigation assisted anterior cervical pedicle screw placement

作　　者：谢兆林[1] 杨克勤[1] 江建中[1] 黄圣斌[1] 李颖[1] 张其标 XIE Zhao-lin;YANG Ke-qin;JIANG Jian-zhong;HUANG Sheng-bin;LI Ying;ZHANG Qi-biao(Department of Orthopaedics,Guigang People's Hospital,Guigang 537100,China)

机构地区：[1]广西贵港市人民医院骨科,广西贵港537100

出　　处：《骨科》2021年第3期226-231,共6页ORTHOPAEDICS

摘　　要：目的探讨“O”型臂导航辅助下颈椎前路椎弓根螺钉(anterior transpedicular screw,ATPS)技术的置钉准确性和手术效果。方法前瞻性收集2016年1月至2019年12月于我院就诊的28例颈椎疾患病人,均在“O”型臂及计算机导航辅助下行颈椎前路病灶切除、植骨及ATPS内固定手术。术后评价ATPS置入的准确率;术前和术后1周、6个月采用疼痛视觉模拟量表(visual analogue scale,VAS)评价病人颈肩疼痛程度;采用日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗分数评价治疗效果;比较病人术前及末次随访时的Frankel神经功能分级。结果28例病人共置入螺钉112枚,其中椎弓根螺钉98枚(0级91枚,1级7枚),椎体螺钉14枚。本组病人术后1周和术后6个月的颈肩痛VAS评分分别为(2.14±0.71)分、(1.18±0.48)分,均显著低于术前的(7.29±1.27)分;术后1周和术后6个月的颈肩JOA评分分别为(13.93±0.98)分、(15.36±0.87)分,均显著高于术前的(9.54±1.32)分;与术前比较,差异均有统计学意义(P均<0.05)。应用颈椎JOA评分,治疗后的评分改善率为77.0%±2.3%。术前Frankel神经功能分级D+E级的人数占比为39.3%(11/28),术后提高至67.9%(19/28),差异有统计学意义(χ^(2)=4.595,P=0.032)。结论导航辅助下ATPS技术是颈椎传统手术技术的一个有益补充,对颈椎椎体破坏严重、颈椎前路内固定翻修、骨质疏松严重等病例有着重要意义,置钉准确率高,手术效果好。Objective To investigate the effect of“O”⁃arm navigation assisted anterior transpedicular screw(ATPS)technique in the treatment of cervical spondylosis.Methods Totally,28 patients with cervical spondylosis who were treated in our hospital from January 2016 to December 2019 were prospectively collected.The“O”⁃arm machine and computer navigation were used to assist the cervical spine lesions resection,bone grafting and ATPS internal fixation.The accuracy of anterior pedicle screw placement was evaluated postoperatively.Visual analogue scale(VAS)was used to evaluate the degree of pain before operation,1 week and 6 months after operation.Japanese Orthopaedic Association(JOA)score was used to evaluate the treatment effect.The Frankel neurologic grading before operation and at the last follow⁃up was compared.Results A total of 112 screws were inserted in 28 patients,including 98 pedicle screws(91 for grade 0,7 for grade 1)and 14 vertebral screws.VAS score of neck and shoulder pain at 1st week and 6th month after operation was 2.14±0.71 and 1.18±0.48 respectively,significantly lower than that before operation(7.29±1.27)(P<0.05).The JOA score of neck and shoulder pain at 1st week and 6th month after operation was 13.93±0.98 and 15.36±0.87 respectively,significantly higher than that before operation(9.54±1.32)(P<0.05).The cervical spine JOA scores showed an improvement rate of 77.0%±2.31%after treatment.The number of patients with D+E levels of Frankel nerve function grade was 11/28(39.3%)before operation,and 19/28(67.9%)after operation(χ^(2)=4.595,P=0.032).Conclusion Navigation for the ATPS placement technique is a useful supplement to the traditional cervical spine surgical technique.It is a great of significance to some cases like severe cervical vertebral body destruction,anterior cervical internal fixation revision,and severe osteoporosis because of accurate and good surgical results.

关 键 词：O臂导航 颈椎 前路椎弓根置钉 

分 类 号：R687.3[医药卫生—骨科学]