透视及导航下颈椎椎弓根螺钉内固定术的临床应用经验

目的　报告使用透视下及无线主动式红外诱导计算机导航引导下进行颈椎椎弓根钉固定手术的经验 ,分析手术成功的要素。方法　自 2 0 0 1年 10月至 2 0 0 2年 12月共行颈椎椎弓根螺钉 -AXIS钛板内固定 2 9例 ,男性 18例 ,女性 11例。年龄 2 6岁～ 76岁 ,平均年龄 4 9.4岁。使用C形臂X线透视下螺钉置入 2 5例 ,无线主动式红外诱导计算机导航下椎弓根内固定 4例。共置入椎弓根螺钉 174枚。结果　 174枚螺钉中有 15 5枚 (89% )位置正确。 19枚螺钉存在不同程度的偏差 ,均为内倾不够 ,1例出现一过性神经根合并症。计算机导航置入螺钉 2 4枚 ,位置正确率 10 0 %。术前颈椎后凸者固定节段曲度平均- 12 .1°术后平均 - 0 .6° ,明显得到纠正。术后 3个月和 6个月的随诊 ,颈椎曲度和固定节段椎体高度均维持 ,没有出现内固定物松动 ,螺钉断裂等情况。结论　颈椎椎弓根钉固定手术是颈椎获得牢固固定的方法 ,为颈椎后路手术提供了更广的操作空间 ,免去部分同时前路手术的需要 ,而且可以用于颈椎后凸的矫正。但是结构的复杂性和变异性及周围的神经血管使手术难度加大 ,在透视下可以比较安全地置入螺钉 ,更好的方法是使用计算机导航技术。这一技术具有良好的临床应用前景。

Experience of pedicle screw fixation in the cervical spine using navigation system

Objective To introduce the usage of C-arm imaging and infrared ray active inducement calculator navigation system to perform the cervical pedicle fixation. Methods From October 2001to December 2002, 29 cases were performed pedicle screw fixation in the cervical spine. Among these patients, there were 18males and 11females. The ages ranged from 26 to 76, and the average age was 49.4years old. 25 cases were performed by using the C-arm imaging, the other four cases by using the navigation system. Totally 174 screws were implanted. Results 155 of 174 screws were in correct position and 19 screws were incorrect. One of the incorrect patients appeared the cervical root symptoms. The24 screws implanted by using the navigation system got 100% correction rate. The cervical kyphosis was improved from average-12.1 degree preoperatively to-0.6 degree postoperatively. In the follow-up at 3 months and 6 months the anterior curve and height of involved levels in all of these cases were remained favorable. There was no loosening or failure of cervical pedicle screws occurred. Conclusion Cervical pedicle screw was a strong fixation in cervical spine with no necessary to add to anterior fixation. It can be easily performed after laminectomy. Meanwhile it can be used incorrectingcervical kyphosis. Owing to complex structure and nerves and vessels nearby made it very difficult to control the correct screw path.C-arm fluoroscopy is a good control method now, but the calculator navigation system seems to have good prospect.