电磁导航引导经皮椎弓钉固定胸腰椎爆裂骨折  

Electromagnetic navigation guided percutaneous pedicle screw for thoracolumbar burst fractures

作　　者：祁玉辉 孔鹏[2] 汲长蛟[2] 樊春阳 张建新[2] QI Yu-hui;KONG Peng;JI Chang-jiao;FAN Chun-yang;ZHANG Jian-xin(The First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Department of Minimally Invasive Orthopedics,Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]山东中医药大学附属医院微创骨科,山东济南250014

出　　处：《中国矫形外科杂志》2023年第20期1895-1898,共4页Orthopedic Journal of China

基　　金：山东省中医药科技发展计划项目(编号:2019-0145)。

摘　　要：[目的]介绍电磁导航引导经皮椎弓钉固定胸腰椎爆裂骨折的手术技术和初步临床结果。[方法]2020年1月—2022年1月30例单节段胸腰椎爆裂骨折患者应用电磁导航引导经皮椎弓钉固定。采用全身麻醉,取俯卧位,于手术区域尾侧安放磁场发生器,利用2根克氏针固定患者定位器,安放侧正位导航桥架,依次行侧、正位透视及上传,完成系统匹配。校准导航穿刺针成功后,完成导丝置入,依次经皮置入椎弓钉,再置入双侧棒,紧固钉-棒系统,完成固定。[结果]患者手术均顺利完成,无神经及血管损伤,平均随访时间(12.1±2.3)个月。末次随访时VAS评分[(0.3±0.1),(6.3±0.3),P<0.05]和ODI评分[(3.2±0.6),(40.3±0.8),P<0.05]较术前显著减少。术后1周伤椎后凸Cobb角[(6.4±0.9)°,(23.4±1.6)°,P<0.05]、伤椎前缘压缩率[(3.4±0.5)%,(30.5±2.5)%,P<0.05]均较术前显著减少,随访期间无断钉、断棒、内固定松动等并发症发生。[结论]应用电磁导航引导经皮椎弓钉固定胸腰椎爆裂骨折,能有效恢复伤椎高度,明显减轻患者症状,医患辐射暴露较少,脊柱稳定性恢复好。[Objective]To introduce the surgical techniques and preliminary clinical results of electromagnetic navigation guided per-cutaneous pedicle screw for fixation of thoracolumbar burst fractures.[Methods]From January 2020 to January 2022,a total of 30 patients received electromagnetic navigation guided percutaneous pedicle screw for single-segment thoracolumbar burst fractures.After general an-esthesia,the patients were placed in the prone position,and the magnetic field generator,locator and navigation bridge were placed respec-tively.After the C-arm fluoroscopic image was successfully matched with the electromagnetic navigation system,the pedicle screws were percutaneously placed under the guidance of electromagnetic navigation,following by fastened with the bilateral rods that introduced percu-taneously to finish the fixation.[Results]All the patients were successfully operated on without nerve or vascular injury,and followed up for(12.1±2.3)months on a mean.The VAS scores[(0.3±0.1),(6.3±0.3),P<0.05]and ODI scores[(3.2±0.6),(40.3±0.8),P<0.05]significantly reduced postoperatively compared with those preoperatively.In addition,the local kyphotic Cobb angle[(6.4±0.9)°,(23.4±1.6)°,P<0.05],and compression ratio of the injured vertebra[(3.4±0.5)%,(30.5±2.5)%,P<0.05]significantly declined at the latest follow-up compared with those preoperatively.During the follow-up period,no broken screw,broken rod,internal fixation loosening and other adverse imaging finding was noted in anyone of them.[Conclusion]This electromagnetic navigation guided percutaneous pedicle screw for thoracolumbar burst fracture does effectively restore vertebral height,significantly reduce symptoms,decrease radiation exposure,and resume spinal stabil-ity well.

关 键 词：胸腰椎骨折 电磁导航 经皮椎弓根螺钉 内固定术 

分 类 号：R683.2[医药卫生—骨科学]