S8导航系统辅助矫形与徒手矫形对青少年先天性脊柱侧凸的疗效比较  

Efficacy comparison of the S8 navigation-assisted correction versus manual correction in adolescent congenital scoliosis

作　　者：李帅[1] 贺园 李庆达 高生龙 程新楠 雷育宽 冯铭哲 都金鹏 朱雷[1] 黄云飞 昌震[1] 赵志刚[1] 闫亮[1] 惠华[1] 章雪芳 贺宝荣[1] Li Shuai;He Yuan;Li Qingda;Gao Shenglong;Cheng Xinnan;Lei Yukuan;Feng Mingzhe;Du Jinpeng;Zhu Lei;Huang Yunfei;Chang Zhen;Zhao Zhigang;Yan Liang;Hui Hua;Zhang Xuefang;He Baorong(Department of Spine Surgery,Honghui Hospital,Xi′an Jiaotong University,Xi′an 710054,China;Department of Orthopedics,Xi′an Fifth Hospital,Xi′an 710082,China;Department of Orthopedics,the Second Hospital of Lanzhou University(the Second Clinical College),Lanzhou 730030,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 [2]西安市第五医院骨科,西安710082 [3]兰州大学第二医院(第二临床医学院)骨科,兰州730030

出　　处：《中华医学杂志》2024年第41期3807-3814,共8页National Medical Journal of China

基　　金：陕西省重点研发计划(2023-ZDLSF-03);西安市科技局医学研究一般研究项目(23YXYT0083)。

摘　　要：目的比较S8导航系统辅助矫形与徒手矫形治疗青少年先天性脊柱侧凸(ACS)的疗效。方法队列研究。回顾性分析2021年5月至2023年1月于西安交通大学附属红会医院就诊的48例先天性脊柱侧凸患者的临床及影像学资料。根据使用辅助系统的不同分为两组:S8导航系统辅助下矫形组(导航组,n=20)和C型臂辅助下徒手矫形组(徒手组,n=28)。主要观察指标为:冠状面平衡(CB)、矢状面垂直轴(SVA)、前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骨盆入射角与腰椎前凸角匹配度(PI-LL)、脊柱侧凸研究学会-22量表(SRS-22)。次要观察指标为手术相关情况及术后并发症。结果48例患者中男21例,女27例,年龄(13.3±3.0)岁。两组患者术前C 7铅垂线偏距骶骨中垂线(C 7PL-CSVL)、SVA、LL、PI、PT、PI-LL、SRS-22差异均无统计学意义(均P>0.05)。导航组术后C 7PL-CSVL、SVA均优于徒手组[(12.51±11.86)mm比(19.64±1.33)mm和(15.72±3.64)mm比(25.42±2.53)mm,均P<0.05];两组术后LL、PI、PT、PI-LL、SRS-22差异均无统计学意义(均P>0.05)。导航组0级和0+1级螺钉置入准确率分别为91.17%(93/102)、95.09%(97/102),均高于徒手组的84.45%(125/148)、91.89%(136/148)(均P<0.05)。导航组邻近小关节侵犯率A~C级分别为88.23%(90/102)、11.76%(12/102)、0(0/102),优于徒手组的83.44%(121/145)、8.96%(13/145)、7.58%(11/145)(P=0.015)。导航组手术时间、单钉置入时间、总钉置入时间短于徒手组,螺钉距皮质距离近于徒手组(均P<0.05)。徒手组术中出血量高于导航组(P<0.05)。导航组平均曲线矫正率(74.68%±10.70%)优于徒手组(59.60%±6.90%)(P<0.001)。导航组术中透视剂量高于徒手组[(416±70)mGy比(360±81)mGy,P=0.015]。导航组切口长度长于徒手组(P<0.05)。两组患者术前疼痛视觉模拟评分(VAS)差异无统计学意义(P>0.05),术后3 d导航组VAS优于徒手组[(2.60±0.22)分比(3.10±0.32)分,P<0.001],两组其余时间点VAS差异均无统计学Objective Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis(ACS).MethodsA cohort study.A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi′an Jiaotong University between May 2021 and January 2023.Based on the auxiliary systems,the patients were divided into two groups:the S8 navigation system-assisted correction group(navigation group,n=20)and the C-arm-assisted manual correction group(manual group,n=28).The primary outcome measures were coronal balance(CB),sagittal vertical axis(SVA),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),pelvic incidence-lumbar lordosis mismatch(PI-LL),and the Scoliosis Research Society-22(SRS-22)questionnaire.The secondary outcome measures included surgery-related conditions and postoperative complications.ResultsOf the 48 patients,there were 21 males and 27 females,with a mean age of(13.3±3.0)years.There was no statistically significant differences in preoperative distance of C 7 plumb line to center sacral vertical line(C 7PL-CSVL),SVA,LL,PI,PT,PI-LL mismatch,or SRS-22 scores between the two groups(all P>0.05).Postoperatively,the C 7PL-CSVL and SVA in the navigation group were both better than in the manual group[(12.51±11.86)mm vs(19.64±1.33)mm,(15.72±3.64)mm vs(25.42±2.53)mm,both P<0.05].There was no statistically significant differences in postoperative LL,PI,PT,PI-LL mismatch,or SRS-22 scores between the two groups(all P>0.05).The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17%(93/102)and 95.09%(97/102)in the navigation group,respectively,which were higher than those in the manual group[84.45%(125/148)and 91.89%(136/148),respectively](both P<0.05).The rates of adjacent facet joint violation in Grades A,B,and C were 88.23%(90/102),11.76%(12/102),and 0(0/102)in the navigation group,respectively,which were all better than those i

关 键 词：脊柱侧凸 青少年先天性脊柱侧凸 S8导航系统 半椎体 矫形 

分 类 号：R687.3[医药卫生—骨科学]