O形臂导航系统辅助上颈椎椎弓根螺钉内固定治疗创伤性寰枢椎失稳  

O-arm navigation system-assisted upper cervical pedicle screw internal fixation for traumatic atlantoaxial instability

作　　者：赵松川 闫亮[1] 惠华[1] 刘忠凯 昌震[1] 李亮[1] 郝定均[1] 贺宝荣[1] Zhao Songchuan;Yan Liang;Hui Hua;Liu Zhongkai;Chang Zhen;Li Liang;Hao Dingjun;He Baorong(Department of Spine Surgery,Affiliated Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054

出　　处：《中华创伤杂志》2023年第12期1079-1085,共7页Chinese Journal of Trauma

摘　　要：目的探讨O形臂导航系统辅助上颈椎椎弓根螺钉内固定治疗创伤性寰枢椎失稳的疗效。方法采用回顾性队列研究分析2021年1月至2022年6月西安交通大学附属红会医院收治的61例寰枢椎失稳患者的临床资料,其中男34例,女27例;年龄20~77岁[(50.2±13.1)岁]。38例采用徒手置钉(徒手组),23例采用O形臂导航系统辅助置钉(导航组)。徒手组按照手术医师的经验(是否具有20年及以上脊柱外科手术经验,并独立完成寰枢椎手术100例以上)分为经验丰富组(20例)和经验不丰富组(18例)。记录各组置钉时间、手术时间。术后7 d复查颈椎CT,根据Neo分级标准评价椎弓根螺钉的置钉满意率和皮质穿破率。术前、术后7 d及末次随访时采用日本骨科学会(JOA)评分及颈部功能障碍指数(NDI)评估患者颈椎神经功能。观察并发症发生情况。结果患者均获随访9~25个月[(16.3±4.2)个月]。导航组置钉时间和手术时间与徒手组比较差异无统计学意义(P均>0.05)。导航组置钉时间为(41.0±7.8)min,较徒手组中经验丰富组的(23.6±6.8)min长(P<0.01),较经验不丰富组的(50.1±10.1)min短(P<0.05)。导航组手术时间为(101.9±9.9)min,较徒手组中经验丰富组的(67.6.±8.3)min长(P<0.01),较经验不丰富组的(126.1±16.4)min短(P<0.01)。导航组置钉满意率和置钉皮质穿破率分别为98.9%、4.3%,优于徒手组的94.1%、17.8%,且优于徒手组中经验丰富组的96.2%、13.8%和经验不丰富组的91.7%、22.2%(P<0.05或0.01)。导航组和徒手组术前、术后7 d及末次随访时JOA评分和NDI差异无统计学意义,且与徒手组中经验丰富组和经验不丰富组差异无统计学意义(P均>0.05)。导航组和徒手组术中均未见脊髓神经、血管损伤等并发症。结论O形臂导航系统辅助上颈椎椎弓根螺钉内固定治疗寰枢椎失稳在置钉时间、手术时间、术后神经功能等方面与徒手置钉无明显差异,但具有更高的置钉准�Objective To explore the efficacy of O-arm navigation system-assisted upper cervical pedicle screw internal fixation in the treatment of traumatic atlantoaxial instability.Methods A retrospective cohort study was conducted to analyze the clinical data of 61 patients with atlantoaxial instability admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2021 to June 2022,including 34 males and 27 females,aged 20-77 years[(50.2±13.1)years].A total of 38 patients were treated with unarmed screw placement(unarmed group),and 23 with O-arm navigation system-assisted screw placement(navigation group).The unarmed group was divided into experienced group(n=20)and unexperienced group(n=18)based on the surgeons′experience(whether they had 20 years or longer experience of spinal surgery and performed more than 100 atlantoaxial surgeries independently).The screw placement and surgical time of each group was recorded.The cervical CT scan was conducted at 7 days after surgery to evaluate the satisfaction rate of pedicle screw placement and cortical penetration rate according to Neo grading criteria.The cervical nerve function of the patients before,at 7 days after surgery and at the last follow-up was evaluated using the Japanese Orthopedic Association(JOA)score and the Neck Disability Index(NDI).The occurrence of complications was observed.Results All patients were followed up for 9-25 months[(16.3±4.2)months].There were no statistically significant differences in the screw placement and surgical time between the navigation group and the unarmed group(all P>0.05).The screw placement time of the navigation group was(41.0±7.8)minutes,longer than that of the experienced group[(23.6±6.8)minutes](P<0.01)and shorter than that of the unexperienced group[(50.1±10.1)minutes](P<0.05).The surgical time of the navigation group was(101.9±9.9)minutes,which was longer than that of the experienced group[(67.6±8.3)minutes](P<0.01)and shorter than that of the unexperienced group[(126.1±16.4)minutes](P<0.01).T

关 键 词：寰枢关节 关节不稳定性 O形臂导航 

分 类 号：R687.3[医药卫生—骨科学]