O-arm导航辅助与徒手后路椎弓根螺钉复位内固定治疗寰枢椎骨折的疗效比较

目的探讨O-arm导航辅助下后路椎弓根螺钉复位内固定治疗寰枢椎骨折的疗效。方法采用回顾性病例对照研究分析2016年1月至2018年6月河北医科大学第三医院收治的37例寰枢椎骨折患者临床资料,其中男22例,女15例;年龄29~68岁(50.9±9.8)岁]。24例行O-arm导航辅助下后路椎弓根螺钉复位内固定术(导航组),13例行徒手后路椎弓根螺钉复位内固定术(徒手组)。比较两组手术时间和术中出血量。术前、术后7 d及末次随访采用日本骨科学会(JOA)评分和颈椎功能障碍指数(NDI)评分对患者临床疗效进行评估。观察患者并发症情况。采用Neo分级评价螺钉位置分级及皮质穿透率。结果者均获随访24~38个月(27.7±4.0)个月]。导航组手术时间(189.8±35.4)min]显著短于徒手组(221.5±48.6)min](P<0.05),术中出血量300.0(250.0,537.5)ml]〖显著少于徒手组500.0(425.0,625.0)ml](P<0.05)。两组患者术后7 d及末次随访JOA评分较术前显著升高(P<0.05),NDI评分较术前显著降低(P<0.05)。而组间差异无统计学意义(P>0.05)。术中未见神经、血管损伤等严重相关并发症。导航组共置入椎弓根螺钉86枚,包括Neo分级0级83枚,1级2枚,2级1枚;徒手组共置入椎弓根螺钉44枚,包括Neo分级0级36枚,1级5枚,2级2枚,3级1枚(P<0.05)。导航组螺钉皮质穿透率为3%(3/86),徒手组为18%(8/44)(P<0.05)。结论对于寰枢椎骨折,在行后路椎弓根螺钉复位内固定术时,应用O-arm导航辅助可以显著缩短或减少手术时间和术中出血量,提高椎弓根螺钉置入的精确率。

Efficacy of posterior pedicle screw reduction and internal fixation of atlantoaxial fractures:comparison between O-arm navigation assisted and free-hand techniques

Objective To investigate the effect of O-arm navigation assistedl posterior pediclescrew rerluction and internal fixation of atlantoaxial fractures.Methods A retrospective case-controlstudy was conducted to analyze 37 patients with atlantoaxial fractures admitted to Third Hospital of HebeiMedical University from January 2016 to June 2018,including 22 muales and l5 females,aged from 29 to68 years(50.9±9.8)years].The posterior pedicle screw reduction and internal fixation was performedunder O-arm navigation system(navigation group,n=24),and using free-hand technique(free-handgroup,n=13).The operation time and blood loss were compared between the two groups.The JapaneseOrthopaedic Association(JO.A)score and neck disability index(NDI)were used to evaluate the clinicalefficacy before operation,7 days operation and at the last follow-up.The complications were detected.Atotal of 86 screws were placed in navigation group(Neo grade 0:83 screws,grade 1:2 screws,grade 2:l screw),and 44 screws were inserted in free-hand group(Neo grade 0:36 screws,grade l:5 screws,grade 2;2 screws,grade 3:l screw)(P<0.05).Classification of screw positions proposed by Neo et alwas uscd to evaluate the position relationship between the screw and the bone cortex and the incidence of screw penetration.Results All patients were followed up 24-38 months(27.7±4.0)months].Theoperation time in navigation group was(189.8±35.4)minutes,significantly shorter than(221.5±48.6)minutes in free-hand group(P<0.05).The bleeling volume in navigation group was 300.0(250.0.537.5)ml,significantly less than 500.0(425.0,625.0)ml in free-hand group(P<0.05).Bothgroups showed significantly enhancedl JOA and decreasexd NDI after operation and at last follow-up,compared with those before operation(P<0.05).However,there was no significant difference in JOAand NDI between the two groups(P>0.05).No severe complications such as neurovascular injuryoccurred during operation.The incidence of cortical penetration was 3%(3/86)in navigation group and18%(8/44)in free-hand group(P<0.05).Conclusions ln the process of posterior atlantoaxialpedicle screw placement,the application of O-arm navigation can significantly reduce the operation timeand amount of bleeding,and enhance the accuracy of pelicle screw implantation.