三维计算机导航辅助下伴严重骨盆倾斜神经肌源性脊柱侧凸经S_(2)骶髂螺钉的精准置入  

Neuromuscular scoliosis with severe pelvic obliquity:the accuracy of S_(2) AI screw placement by O-arm three-dimensional CT navigation

作　　者：凌宸 汤子洋 刘臻[2] 胡宗杉 朱泽章[1,2] 邱勇[1,2] Ling Chen;Tang Ziyang;Liu Zhen;Hu Zongshan;Zhu Zezhang;Qiu Yong(Department of Spine Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院脊柱外科,210008 [2]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2021年第24期1785-1794,共10页Chinese Journal of Orthopaedics

基　　金：南京市十三五青年人才第三人次(QRX17126);国家自然科学基金(82072518)。

摘　　要：目的探讨"O"型臂三维计算机导航系统在伴严重骨盆倾斜的神经肌源性脊柱侧凸患者术中置入经S_(2)骶髂螺钉(second sacral alar-iliac,S_(2)AI)的可行性和准确性。方法回顾性分析2017年1月至2020年8月收治伴严重骨盆倾斜的神经肌源性脊柱侧凸28例患者的病历资料,男12例,女16例;年龄10~51岁,平均22.2岁;骨盆倾斜角27.54°±9.90°(范围16.2°~53.6°)。术前行骨盆螺旋CT薄层扫描和三维重建,应用LightSpeed系统模拟理想的S_(2)AI钉道;选择第1骶孔外缘1 mm垂线与下缘1 mm水平线的交点为进钉点,旋转三维骨盆图像找到髂骨骨髓腔最长且最宽的骨盆横断面,在此横断面穿过髂骨中央部位的直线即为理想的S_(2)AI钉道;测量其矢状面尾向偏角(sagittal angle,SA)、横断面外向偏角(transverse angle,TA)及钉道最大长度(maximal length,ML)。术中均在"O"型臂三维计算机导航辅助下置入S_(2)AI固定骨盆,术后测量实际置入S_(2)AI的钉道参数(即SA、TA)并评价S_(2)AI置入的准确性。结果所有患者均可重建出理想的S_(2)AI钉道,该钉道穿过骶骨和骶髂关节后穿行于髂骨内。骨盆倾斜的高侧和低侧SA分别为30.20°±21.94°(范围-25.80°~73.10°)和50.94°±16.02°(范围12.60°~88.50°),差异有统计学意义(t=3.990,P<0.001);骨盆旋转的旋前侧和旋后侧SA分别为30.14°±21.93°(范围-25.80°~73.10°)和51.00°±15.96°(范围12.60°~88.50°),差异有统计学意义(t=4.027,P<0.001)。骨盆倾斜的高侧和低侧TA分别为43.67°±12.86°(范围7.40°~66.70°)和31.95°±13.80°(范围8.30°~71.10°),差异有统计学意义(t=2.834,P=0.009);骨盆旋转的旋前侧和旋后侧TA分别为42.56°±12.52°(范围7.40°~63.50°)和33.05°±14.94°(范围8.30°~71.10°),差异有统计学意义(t=2.192,P=0.037)。骨盆倾斜的高侧和低侧ML分别为(97.12±12.44)mm(范围80.32~121.38 mm)和(92.28±11.04)mm(范围72.85~116.59 mm),差异无统计学意义(t=0.963,P=0.060);骨盆旋转的旋Objectives:To investigate the feasibility of second sacral alar-iliac(S_(2) AI)screw placement and trajectories index in patients with neuromuscular scoliosis with severe pelvic obliquity;and to explore the accuracy of S_(2) AI screw placement by O-arm three-dimensional(3D)CT navigation(Medtronic,Minneapolis,MN,USA).Methods:All of 28 patients with neuromuscular scoliosis who underwent posterior long fusion with S_(2) AI between January 2017 and August 2020 were reviewed,with an average age of 22.2 years old(ranged from 10 to 51 years),and the pelvic obliquity angle was 27.54±9.90°(ranged from 16.2°to 53.6°).Based on 3D CT reconstruction of these specimens,virtual S_(2) AI screw channels were identified and measured.Entry point was determined by 1 mm inferior and 1 mm lateral to the S 1 dorsal foramen,and virtual S_(2) AI screw trajectories with maximum length and width were explored by rotating 3D pelvis.The parameters of the determined channels were measured including caudal angulation on the sagittal plane(sagittal angle,SA),lateral angulation on the transverse plane(transverse angle,TA)and the maximal length of the channel(maximal length,ML).The accuracy of screw placement was evaluated by postoperative pelvic CT scan.Results:All of the virtual S_(2) AI screw trajectories can be reconstructed.The screw trajectory parameters were shown as follows:SA was 30.20°±21.94°and 50.94°±16.02°on the high and low sides of pelvis,respectively,and the difference was statistically significant(t=3.990,P<0.001).SA was 30.14°±21.93°on the anterior side of the pelvis and 51.00°±15.96°on the posterior side,respectively,with statistical significance(t=4.027,P<0.001).TA was 43.67°±12.86°on the high side of pelvic tilt and 31.95°±13.80°on the low side,with statistical significance(t=2.834,P=0.009).TA was 42.56°±12.52°on the anterior side of the pelvis and 33.05°±14.94°on the posterior side,respectively,and the differences were statistically significant(t=2.192,P=0.037).ML was 97.12±12.44 mm and 92.28±11

关 键 词：脊柱侧凸 骨盆 骨螺丝 外科手术 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]