数字骨科3D重建技术辅助腰椎椎弓根螺钉置入的精确性临床研究  

A clinical trial on precision of lumbar pedicle screw placement assisted by digital 3D orthopedic reconstruction techniques

作　　者：卢冬焱 王延斌 高洪辉 王霄汉 杨波[2] 王簕[2] 寇程新 蒲元广 蒋柒 LU Dongyan;WANG Yanbin;GAO Honghui;WANG Xiaohan;YANG Bo;WANG Le;KOU Chengxin;PU Yuanguang;JIANG Qi(Department of Orthopedics and Traumatology,Haizhu District Hospital of Traditional Chinese Medicine,Guangzhou 510220,China;Department of Spine Surgery,Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Second Division,Geriatric Orthopedics,Sichuan Provincial Orthopedics Hospital,Chengdu 610000,Sichuan,China)

机构地区：[1]广州市海珠区中医医院骨伤科,广东广州510220 [2]广州医科大学附属第三医院脊柱外科,广东广州510150 [3]四川省骨科医院老年骨科二病区,四川成都610000

出　　处：《广州医科大学学报》2023年第3期25-31,共7页Academic Journal of Guangzhou Medical University

基　　金：2019年国家教育部第二批教育部产学研合作育人项目(201902117001)。

摘　　要：目的:探讨应用数字骨科3D重建技术辅助腰椎椎弓根钉置入可行性及精确性。方法:选取广州市海珠区中医医院骨伤科及广州医科大学附属第三医院2021年10月至2022年9月因腰椎退行性病变行腰椎椎间融合减压+椎弓根螺钉内固定术的患者40例,随机分成试验组(虚拟三维模型辅助置钉组)和对照组(传统徒手置钉组),每组20例,试验组予数字骨科3D重建技术辅助置入腰椎椎弓根钉,对照组采用解剖标志及术者经验置入腰椎椎弓根钉。比较两组术前、术后第14天、术后第1个月、末次随访的VAS评分和置钉完成平均时间、平均失血量、总透视次数、钉道调整次数、置钉准确度(一次性置钉成功率、置钉准确率及置钉优良率)、并发症等指标。结果:两组术后第14天、术后第1个月、末次随访的VAS评分与术前比较,差异有统计学意义(P<0.05);两组置钉完成平均时间(试验组为5.25±1.33 min,对照组为10.10±3.42 min)、平均失血量(试验组为10.05±1.82mL,对照组为17.20±3.05mL)、总透视次数(试验组为2.35±0.59次,对照组为3.35±0.76次)、钉道调整次数(试验组为1.2±0.52次,对照组为1.90±0.73次)比较差异具有统计学意义(P<0.05);试验组一次性置钉成功率为(95.83%)明显高于对照组(87.23%)(P<0.05)。结论:脊柱手术中置入椎弓根螺钉时应用数字骨科3D重建技术进行虚拟三维模型重建可获得更满意的置钉效果,值得在临床上推广应用。Objective:To investigate the feasibility and precision of lumbar pedicle screw placement assisted by digital 3D orthopedic reconstruction techniques.Methods:Forty patients were included who underwent lumbar decompression via interbody fusion and internal fixation with pedicle screws in Department of Orthopedics and Traumatology at Guangzhou Haizhu District Hospital of Traditional Chinese Medicine and in Third Affiliated Hospital of Guangzhou Medical University between October 2021 and September 2022.These patients were randomLy divided into the study group(virtual 3D model-assisted screw placement group)and the control group(conventional freehand screw placement group),with 20 patients in each group.In the study group the insertion of lumbar pedicle screws was completed with assistance of digital 3D orthopedic reconstruction techniques,whereas in the control group,the D0I:10.3969/j.issn.2095-9664.2023.03.05 procedure was done according to anatomical landmarks and expertise of the manipulator.The VAS scores,mean screw placement time,mean blood loss,total number of fluoroscopy shots,times of screw track adjustment,and precision of screw placement(first-attempt success rate,rate of precise placement,and rate of proper screw placement),and complications were compared between the two groups.Results:Compared with preoperative baseline,statistically significant difference in the VAS scores on day 14,at 1 month after surgery,and on the last follow-up was noted in either group(P<0.05).The study group and the control group also varied significantly in the mean screw placement time(5.25±1.33 min vs 10.10±3.42 min),mean blood loss(10.05±1.82 mL vs 17.20±3.05 mL),total number of fluoroscopy shots(2.35±0.59 shots vs 3.35±0.76 shots),and times of screw track adjustment(1.2±0.52 times vs 1.90±0.73 times)(P<0.05).The success rate of screw placement at one-attempt was obviously higher in the study group than that in the control group(95.83%vs 87.23%,P<0.05).Conclusion:Virtual 3D model reconstruction based on digital 3D ort

关 键 词：数字骨科技术 前瞻性研究 术前规划 腰椎椎弓根螺钉 3D重建 虚拟模型 

分 类 号：R681[医药卫生—骨科学]