O型臂导航系统辅助椎弓根外侧In-Out-In螺钉置入技术在先天性脊柱侧凸矫形术中的应用  

Effect of In-Out-In pedicle screw technique assisted by O-arm navigation system in congenital scoliosis correction

作　　者：李玉伟[1] 李修智 严晓云[1] 潘传红[1] 崔巍[1] 王海蛟[1] LI Yuwei;LI Xiuzhi;YAN Xiaoyun;PAN Chuanhong;CUI Wei;WANG Haijiao(Department of Spinal Cord,Luohe Central Hospital,Luohe,Henan 462000,China;Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]漯河市中心医院脊柱科,河南漯河462000 [2]北京大学第三医院骨科,北京100191

出　　处：《中华实用诊断与治疗杂志》2024年第7期689-694,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省高等学校重点科研项目(24B320010);河南省医学科技攻关计划联合共建项目(LHGJ2020230937)。

摘　　要：目的 观察先天性脊柱侧凸患者在O型臂导航系统辅助下采用In-Out-In螺钉置入技术于狭小变异椎弓根外侧置钉进行内固定的疗效,探讨其安全性。方法 回顾性分析2019年1月—2021年1月漯河市中心医院行脊柱侧凸矫形术的17例先天性脊柱侧凸患者的临床资料。术中在O型臂导航系统辅助下,对狭小变异椎弓根采用In-Out-In螺钉置入技术沿椎弓根外侧内斜置入螺钉,对发育正常椎在椎弓根植入椎弓根螺钉,内固定矫正侧、后凸畸形。置钉后应用O型臂扫描评估置钉准确性,椎体间残余间隙置入碎骨粒,融合范围内的横突及其他后方结构表面去皮质后植骨。记录手术情况、术中一次性置钉成功情况。随访至2023年12月,记录术后脊髓损伤、脑脊液漏及切口感染、螺钉及棒松动移位、断裂等并发症发生情况。术前及术后1周、1年行站立位脊柱全长正侧位X线片检查,记录侧凸Cobb角、后凸Cobb角,计算矫正率;比较术前及术后1周、1年脊柱侧凸研究学会(SRS)-22评分;末次随访时采用Eck融合分级标准评估植骨融合情况。结果 (1)17例手术时间(184.0±43.2)min,术中出血量(632.0±192.7)mL,固定节段最高T_5、最低S_1,固定融合节段(9.0±2.7)个。置入椎弓根螺钉216枚,其中椎弓根置入152枚、椎弓根外侧采用In-Out-In技术置入64枚,均一次性置钉成功,O型臂扫描显示螺钉均贴近椎弓根内壁进入椎体,未侵入椎管。(2)随访至2023年12月,随访(28.0±3.4)个月,17例均无脊髓损伤、脑脊液漏及切口感染、螺钉及棒松动移位、断裂并发症发生。17例术前侧凸Cobb角[(57.8±6.6)°]、后凸Cobb角[(44.0±9.6)°]均大于术后1周[(12.6±4.2)°、(15.3±2.4)°]、术后1年[(15.3±2.4)°、(15.4±2.3)°](P<0.05),术后1周与术后1年比较差异无统计学意义(P>0.05)。术后1周侧凸Cobb角矫正率[(77.6±8.6)%]、后凸Cobb角矫正率[(63.9±8.4)%]与术后1年[(76.8±7.1)%、(63.6±8.6)%]�Objective To observe the effect and safety of internal fixation of narrow and variant pedicle using the lateral In-Out-In pedicle screw technique with the assistance of the O-arm navigation system in patients with congenital scoliosis.Methods Seventeen patients with congenital scoliosis underwent correction surgery in Luohe Central Hospital from January,2019to January,2021,and their clinical data were retrospectively analyzed.During the procedure,with the assistance of O-arm navigation system,the screws were obliquely inserted into the narrow and variant pedicle along the lateral side using In-Out-In technique,or into the normal pedicle for internal fixation to correct lateral and posterior convex deformities.After screw placement,the accuracy of screw placement was evaluated using the O-arm machine scan.After satisfactory correction,residual gaps between vertebral bodies were filled with bone grafts,and the surfaces of transverse processes and other posterior structures within the fusion range were decorticated before bone grafting.The intraoperative details and the success of screw placement in one attempt were recorded.A follow-up was conducted till December,2023,to record the occurrences of postoperative complications such as spinal cord injury,cerebrospinal fluid leakage,incision infection,screw and rod loosening or displacement,and fractures.The full-length anteroposterior and lateral X-rays of the spine were obtained 1week and 1year postoperatively to record Cobb angles of lateral and posterior convexities,and to calculate the correction rate.The Scoliosis Research Society-22(SRS-22)scores were compared before operation,and 1week and 1year postoperatively.At the latest follow-up,the bone fusion status was evaluated using the Eck fusion grading system.Results(1)The operation lasted for(184.0±43.2)min averagely,with an intraoperative blood loss of(632.0±192.7)mL.The highest instrumented vertebrae was T_5,and the lowest one was S_1.Totally9.0±2.7segments were fixed and fused,and 216pedicle screws were inse

关 键 词：先天性脊柱侧凸 脊柱侧凸矫形术 O型臂导航系统 In-Out-In螺钉置入技术 

分 类 号：R687.3[医药卫生—骨科学]