CT三维导航系统辅助胸椎椎弓根钉治疗胸椎骨折

目的 探讨CT三维导航技术在胸椎椎弓根钉植入手术中的应用方法和植钉准确性.方法 采用CT三维导航技术对24例胸椎骨折患者行椎弓根钉(102枚)植入手术进行立体引导,术后行CT内固定层面扫描,观察椎弓根螺钉植入的准确性.同时总结C臂机透视引导下22例胸椎骨折椎弓根钉(98)的植钉准确性,并与CT三维导航引导组进行对比分析.结果 术后CT扫描显示CT三维导航组102枚胸椎椎弓根钉I级99枚(97.1%),Ⅱ级(突破椎弓根皮质≤2 mm)3枚,Ⅲ级(突破椎弓根皮质>2 mm)0枚.Ⅱ级有1枚螺钉位置偏于椎弓根内侧,其余均偏在椎弓根外侧.c臂机透视组98枚胸椎椎弓根钉I级88枚(89.8%),Ⅱ级8枚,Ⅲ级2枚.Ⅱ级和Ⅲ级所有螺钉位置偏于椎弓根外侧,Ⅲ级中一例患者出现顽固性胸背痛.余两组临床无神经损伤症状.两组I级差异有统计学意义(P<0.05).结论 计算机辅助导航技术利用CT三维重建影像进行术中导航给术者提供即时的,多维的清晰图像,准确地按照计算机设计的精确进钉路线进行手术内固定.提高了胸椎椎弓根钉植入的安全性和精确性.

Pedicle screw fixation of thoracic spinal fracture assisted by CT-based navigation system

Objective To evaluate the feasibility and accuracy of thoracic pedicle screw fixation when assisted by a CT-based navigation system.Methotis A total of 102 thoracic pedicle screws inserted by a CT-based navigation system(n=24)(Group A)and 98 thoracic pedicle screws inserted by X-ray fluoroscopy (n=22) (Group B) were obsenred by postoperative CT scan.The accuracy of both series was compared.And the process of navigation was investigated.Results Among Group A,99 were of grade I (97.1%),3 grade Ⅱ and 0 grade Ⅲ;among Group B,88 were of grade I(89.8%),8 grade Ⅱ and 2 grade Ⅲ.One patient of grade Ⅲ had the intractable pain of chest and back.Neural damage Was not demonstrated.The difference was statistically significant(P<0.05).Conclusion A CT-based navigation system Can increase accuracy of thoracic pedicle screw fixation.