点状接触式钳型固定导航模板在脊柱侧凸复杂椎弓根置钉中的应用  

The effectiveness of pedicle navigation template with point-contact clamping fixation in complex pedicle of scoliosis

作　　者：王力航 陈啟鸰 陆廷盛 姚书眈 罗春山 Wang Lihang;Chen Qiling;Lu Tingsheng;Yao Shudan;Luo Chunshan(Department of Spinal Surgery,Beijing Jishuitan Hospital Guizhou Hospital,Guiyang 550004,China)

机构地区：[1]北京积水潭医院贵州医院脊柱外科,贵阳550004

出　　处：《中华骨科杂志》2023年第21期1409-1417,共9页Chinese Journal of Orthopaedics

基　　金：贵州省科技支撑计划项目(黔科合支撑(2020)4Y131,黔科合支撑(2022)一般264)。

摘　　要：目的探讨新型五点定位法点状接触式钳型固定椎弓根导航模板在脊柱侧凸复杂椎弓根置钉中的应用。方法回顾性收集2019年2月至2023年2月北京积水潭医院贵州医院脊柱外科收治的存在椎弓根复杂情况(椎弓根发育不良或椎板融合)的脊柱侧凸患者30例(导航模板组),男11例、女19例,年龄(16.54±6.23)岁(范围7~35岁);匹配60例既往病例资料作为对照组(徒手置钉组),男23例、女37例,年龄(16.72±6.34)岁(范围6~35岁)。于脊柱侧凸矫形术中使用五点定位法点状接触式钳型椎弓根导航模板引导置钉,记录置钉时间、置钉出血量、置钉透视次数、手动改道次数,并评估Rao椎弓根螺钉置入分级及准确率、置钉并发症和主弯矫正率。结果导航模板组30例均顺利完成手术操作,共置入354枚螺钉,徒手置钉组60例共置入727枚螺钉,手术时间分别为(279.45±57.72)、(292.54±58.87)min,术中出血量分别为(921.57±371.32)、(932.83±376.65)ml,差异有统计学意义(t=-2.13,P=0.022;t=-1.87,P=0.024)。导航模板组置钉时间(82.87±24.46)min、置钉出血量(72.25±43.66)ml,徒手置钉组分别为(97.53±25.56)min、(106.53±61.22)ml,两组差异有统计学意义(t=-2.66,P=0.031;t=-2.32,P=0.027)。导航模板组置钉透视次数(4.21±1.11)次、手动改道次数(0.47±0.64)次,徒手置钉组分别为(6.32±1.81)次、(0.93±0.86)次,差异有统计学意义(t=-4.66,P<0.001;t=-2.78,P=0.018)。导航模板组Rao椎弓根螺钉置入分级Ⅰ级329枚、Ⅱ级19枚、Ⅲ级6枚,徒手置钉组Ⅰ级669枚、Ⅱ级45枚、Ⅲ级12枚、Ⅳ级1枚,两组差异无统计学意义(χ^(2)=4.26,P=0.547)。导航模板组置钉准确率为98.31%±3.10%、主弯矫正率为57.85%±9.46%,徒手置钉组为98.21%±4.92%、56.64%±9.22%,差异均无统计学意义(t=0.88,P=0.384;t=0.42,P=0.663)。所有患者术中、术后均未出现神经损伤,未发生大血管损伤,无脑脊液漏、感染、死亡,未出现内固定移位、松动及�Objective To explore the effect of a new 5-point positioning point contact clamping fixation pedicle navigation template in treating cases of scoliosis and complex pedicle.Methods From February 2019 to February 2023,30 patients with scoliosis and complicated pedicle were admitted for orthopedic surgery.There were 11 males and 19 females,with an average age of 16.54±6.23 years(range 7 to 35 years).A total 60 cases treated before February 2019 were matched as a control group,including 23 males and 37 females,with an average age of 16.72±6.34 years(range 6 to 35 years).During the operation,the 5-point positioning point-contact clamping fixation pedicle navigation template was used to guide the screws.Screw placement time,screw placement bleeding volume,fluoroscopy frequency,manual redirection frequency,Rao pedicle screw placement classification and accuracy,screw placement complications,and main curve correction rate were recorded.Results All the 30 cases from the study group successfully underwent the surgery with a total of 354 screws placed,while in the control group a total of 727 screws were placed in 60 cases.The surgery times and intraoperative bleeding volumes for the study group and the control group were 279.45±57.72 min vs.292.54±58.87 min and 921.57±371.32 ml vs.932.83±376.65 ml with significant differences(t=-2.13,P=0.022;t=-1.87,P=0.024).The time for screw placement from the start of skin incision to the placement of the last screw and the bleeding volume during screw placement in the study group and the control group was 82.87±24.46 min vs.97.53±25.56 min and 72.25±43.66 ml vs.106.53±61.22 ml with significant differences(t=-2.66,P=0.031;t=-2.32,P=0.027).The screw placement fluoroscopy frequencies and manual redirection frequencies in the study group and the control group were 4.21±1.11 times vs.6.32±1.81 times and 0.47±0.64 times vs.0.93±0.86 times with significant differences(t=-4.66,P<0.001;t=-2.78,P=0.018).According to the Rao pedicle screw placement classification,the study group had

关 键 词：脊柱侧凸 椎弓根钉 打印 三维 手术导航系统 

分 类 号：R687.3[医药卫生—骨科学]