O型臂导航下脊柱矫形骨盆固定术中经第2骶椎骶髂螺钉进钉点及钉道研究  

Entry point and screw path study of second sacral alar-iliac screw trajectory in spinal pelvic fixation under O-arm navigation

作　　者：范昌盛 李劼 胡宗杉 梁邦恒 凌宸 徐辉 邱勇[1,2] 朱泽章[1,2] 刘臻[1,2] Fan Changsheng;Li Jie;Hu Zongshan;Liang Bangheng;Ling Chen;Xu Hui;Qiu Yong;Zhu Zezhang;Liu Zhen(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008 [2]南京医科大学鼓楼临床医学院骨科脊柱外科,南京210008

出　　处：《中华医学杂志》2024年第41期3800-3806,共7页National Medical Journal of China

基　　金：江苏省333人才计划第三层次((2022)3-1-238);南京大学医学院附属鼓楼医院临床试验资助项目(2022-LCYJ-MS-22)。

摘　　要：目的探讨O型臂3D计算机导航下经第2骶椎骶髂(S_(2)AI)螺钉置入术后的进钉点及钉道参数为退变性脊柱畸形患者徒手置钉提供参考的可行性。方法回顾性分析2017年1月至2022年4月于南京大学医学院附属鼓楼医院接受O型臂3D计算机导航系统辅助置入S_(2)AI螺钉固定的66例退变性脊柱畸形患者的病例资料,男6例,女60例,年龄(64.3±5.9)岁。所有患者术前参考S_(1)孔外缘与下缘1 mm交点为进钉点,术中导航修正,术后行全脊柱CT平扫加3D重建。在术后CT的3D影像上以S_(1)螺钉进钉点作为坐标原点测量双侧S_(2)AI钉的进钉点位置、双侧S_(2)AI螺钉的尾倾偏角(SA)、外向偏角(TA)及进钉点与皮肤的垂直距离(SD),记录患者术中及术后并发症并评估S_(2)AI置钉准确性。比较患者双侧S_(2)AI进钉点坐标及钉道参数的差异。应用组内相关系数(ICC)检验观察者内与观察者间一致性。结果66例患者O型臂导航置入的S_(2)AI螺钉进钉点坐标参数及钉道参数均有良好的观察者内与观察者间一致性(ICC>0.75)。患者左侧进钉点位于S_(1)进钉点外侧(8.08±1.39)mm,尾侧(24.47±2.20)mm;右侧则分别为(8.09±1.41)mm和(24.40±2.54)mm,左右两侧进钉点坐标差异无统计学意义(均P>0.05)。患者左侧TA为46.33°±3.44°,SA为39.14°±6.12°,SD为(60.38±13.37)mm;右侧则分别为46.37°±3.41°、39.59°±5.89°和(60.30±12.24)mm,左右两侧钉道参数差异均无统计学意义(均P>0.05)。所有患者术中及术后2周均无明显神经血管并发症发生,螺钉置入准确率为97.7%(129/132)。结论在退变性脊柱畸形骨盆固定中,O型臂导航辅助下置入S_(2)AI螺钉具有较高的准确率。推荐徒手置钉进钉点位于S_(1)上关节突外下缘交点尾侧24 mm,外侧8 mm,螺钉TA约为46°,SA约为39°。Objective To explore the feasibility of using the entry point and screw path parameters of sacroiliac(S_(2)AI)screws inserted under O-arm 3D computer navigation as a reference for freehand screw insertion in patients with degenerative spinal deformities.MethodsA retrospective analysis was conducted on the clinical data of 66 patients with degenerative spinal deformities who received S_(2)AI screw fixation assisted by the O-arm 3D computer navigation system at Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2017 to April 2022.The patients included 6 males and 60 females,with a mean age of(64.3±5.9)years.Preoperatively,the entry point was set as the intersection of 1 mm from the outer and lower edges of the S_(1) foramen,adjusted intraoperatively by navigation,and verified postoperatively by full spinal CT scans and 3D reconstructions.Using the S_(1) screw entry point as the origin,the position of the bilateral S_(2)AI screw entry points,tailward angulation(SA),outward angulation(TA),and vertical distance from the entry point to the skin(SD)were measured on postoperative CT 3D images.The accuracy of S_(2)AI screw placement and any intraoperative and postoperative complications were recorded.Differences in entry point coordinates and screw path parameters between the left and right sides were compared.The intraclass correlation coefficient(ICC)was used to assess intra-observer and inter-observer agreement.ResultsThe coordinates and screw path parameters for the S_(2)AI screws placed using the O-arm navigation demonstrated good intra-observer and inter-observer consistency(ICC>0.75).The left entry point was located(8.08±1.39)mm laterally and(24.47±2.20)mm caudally from the S_(1) entry point,while the right entry point was(8.09±1.41)mm laterally and(24.40±2.54)mm caudally,with no significant difference between the left and right sides(both P>0.05).The left TA was 46.33°±3.44°,SA was 39.14°±6.12°,and SD was(60.38±13.37)mm;the right TA was 46.37°±3.41°,SA was 39.

关 键 词：脊柱 成人脊柱畸形 退变性脊柱畸形 经第2骶椎骶髂螺钉 置钉 手术导航系统 

分 类 号：R687.3[医药卫生—骨科学]