影像导航引导椎体成形术辅助椎弓钉治疗胸腰段椎体爆裂骨折

目的探讨骨科手术导航系统引导椎体成形术辅助短节段椎弓钉内固定治疗胸腰段椎体爆裂骨折应用的有效性和效果。方法对18例胸腰段椎体爆裂骨折采取采用导航引导下的短节段椎弓钉固定结合钙磷骨水泥灌注椎体成形术，内植完成后即作X线正侧位摄片与导航路径进行吻合测量。结果本组患者术后内植物位置理想，椎弓钉位置评级：理想68枚(94％)，3枚突破椎弓根外侧皮质(4％)，Ⅱ级1枚。术后1周离床负重行走：椎体高度丢失恢复40％，随访12个月后显示椎体高度平均改变0．15％，过伸过屈动力摄片显示固定段无异常活动，未发现有椎弓钉松动、断裂病例。结论导航引导椎弓钉植入及钙磷骨水泥灌注椎体成形术，只需一次X线成像就能做出虚拟的手术环境和路径；使内植物精确植入最佳位置，提高了椎弓钉植入及椎体成形手术的安全性，提高手术疗效。

Computer-assisted Fluoroscopic Navigation Guiding the Treatment of Thoracolumbar Burst Fractures with CPC Vertebroplasty and Short-segment Vertebral Pedicle Screw Fixation

Objective To explore the efficacy of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures. Methods 18 patients with thoracolumbar unstable fractures were treated with short-segment vertebral pedicle screw fixation guided by computer-assisted fluoroscopic navigation, and fractures were reinforced with CPC cement vertebroplasty. Postimplantatively, the implants' images-error between virtual image of fluoroscopy and X-ray image was measured. Results The implant's location was excellent. All patients were allowed sitting-up or bearing body weight one week after operation. The vertebral height restored 40% postoperatively. 12 months after operation the vertebral height only changed 0.15%. Dynamic X-ray films showed no abnormal segment instability and no instrument breaking. Conclusion Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle srew fixation could determine the internal fixation approach and let implants to the precise position by one time of X-ray image. It increases the security of pedicle screw fixation and vertebroplasty.