Position and complications of pedicle screw insertion with or without image-navigation techniques in the thoracolumbar spine：a meta-analysis of comparative studies

Computer-navigated pedicle screw insertion is applied to the thoracic and lumbar spine to attain high insertion accuracy and a low rate of screw-related complications.However,some in vivo and in vitro studies have shown that no advantages are gained with the use of navigation techniques compared to conventional techniques.Additionally,inconsistent conclusions have been drawn in various studies due to different population characteristics and methods used to assess the accuracy of screw placement.Moreover,it is not clear whether pedicle screw insertion with navigation techniques decreases the incidence of screw-related complications.Therefore,this study was sought to perform a meta-analysis of all available prospective evidence regarding pedicle screw insertion with or without navigation techniques in human thoracic and lumbar spine.We considered in vivo comparative studies that assessed the results of pedicle screw placement with or without navigation techniques.PubMed,Ovid MEDLINE and EMBASE databases were searched.Three published randomized controlled trials（RCTs） and nine retrospective comparative studies met the inclusion criteria.These studies included a total of 732 patients in whom 4,953 screws were inserted.In conclusion,accuracy of the position of grade I,II,III and IV screws and complication rate related to pedicle screw placement were significantly increased when navigation techniques were used in comparison to conventional techniques.Future research in this area should include RCTs with well-planned methodology to limit bias and report on validated,patient-based outcome measures.     

Biomechanical comparison of cervical transfacet pedicle screws versus pedicle screws

Background Transfacet pedicle screws provide another alternative for standard pedicle screw placement for plate fixation in the lumbar spine. However, few studies looking at transfacet pedicle screw fixation in the cervical spine are available. Therefore, cervical transfacet pedicle screw fixation and standard pedicle screw fixation techniques were biomechanically compared in this study. Methods Ten fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3-4, C5-6, and C7-T1 levels. On the other side, pedicle screws were placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50° caudally in the sagittal plane and about 45° toward the midline in the axial plane. Screws were placed from the inferior articular process, across the facet complex and the pedicle into the body of the caudal vertebra. The entry point for the pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass, and the direction of the screw was about 45° toward the midline in the axial plane and toward the upper third of the vertebral body in the sagittal plane. After screw placement we performed axial pullout testing. Results All the cervical transfacet pedicle screws and the pedicle screws were inserted successfully. The mean pullout strength for the transfacet pedicle screws was 694 N, while for the pedicle screws 670 N （P=0.013）. In all but six instances （10%）, the pedicle screw pullout values exceeded the values for the transfacet pedicle screws; this occurred three times at the C3/C4 level, twice at the C5/C6 level and once at the C7/T1 level. The greatest pullout strength difference at a single level was observed at the C5/C6 level, with a mean difference of 38 N （t=-1.557, P=0.154）. The C7/T1 level h     

A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

We sought to compare the safety and accuracy of a new free-hand pedicle screw placement technique to that of the conventional technique. One hundred fifty-three consecutive adult patients with simple fracture in the tho- racic or/and lumbar spine were alternately assigned to either the new free-hand or the conventional group. In the new free-hand technique group, preoperative computerized tomography （CT） images were used to calculate the targeted medial-lateral angle of each pedicle trajectory and the pedicle screw was inserted perpendicular to the corresponding supraspinal ligament. In the conventional technique group, the medial-lateral and cranial-caudal angle of each pedicle trajectory was determined by intraoperatively under fluoroscopic guidance. The accuracy rate of pedicle screw placement, the time of intraoperative fluoroscopy, the operating time and the amount of blood loss during operation were respectively compared. All screws were analyzed by using intraoperative ra- diographs, intraoperative triggered electromyography （EMG） monitoring data, postoperative CT data and clinical outcomes. The accuracy rate of pedicle screw placement in the new free-hand technique group and the conven- tional technique group was 96.3% and 94.2% （P 〈 0.05）, respectively. The intraoperative fluoroscopy time of the new technique group was less than that of the conventional technique group （5.37 seconds vs. 8.79 seconds, P 〈 0.05）. However, there was no statistical difference in the operating time and the amount of blood loss during op- eration （P 〉 0.05）. Pedicle screw placement with the free-hand technique which keeps the screw perpendicular to the supraspinal ligament is an accurate, reliable and safe technique to treat simple fracture in the thoracic or lum- bar spine.     

术中实时三维计算机导航辅助置入颈后路C2螺钉的临床应用研究

Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN     

Lumbar spine superior-level facet joint violations: percutaneous versus open pedicle screw insertion using intraoperative 3-dimensional computer-assisted navigation

Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations （FVs） because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures clearly,and may help to lower the rate of FVs during pedicle screw insertion.This study used computed tomography （CT） to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.Methods A prospective study,including 142 patients having lumbar and lumbosacral fusion,was conducted between January 2013 and April 2014.All patients had bilateral posterior pedicle screw-rod instrumentation （top-loading screws） implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures.All patients underwent CT examinations within 6 months postoperation.The CT scans were independently reviewed by three reviewers blinded to the technique used.Results The cohort comprised 68 percutaneous and 74 open cases （136 and 148 superior-level pedicle screw placements,respectively）.Overall,superior-level FVs occurred in 20 patients （20/142,14.1％）,involving 27 top screws （27/284,9.5％）.The percutaneous technique （7.4％ of patients,3.7％ of top screws） had a significantly lower violation rate than the open procedure （20.3％ of patients,14.9％ of top screws）.The open group also had significantly more serious violations than did the percutaneous group.Both groups had a higher violation rate when the cranial fixation involved the L5.A 1-level open procedure had a higher violation rate than did the 2-and 3-level surgeries.Conclusions With computer-assisted navigation,the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur,they tend to be less serious.Performing a single-level open lumbar fusion,or the fusion of the L5-S1 segment,requires     

Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring

Background  Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery, because they may have advantage over conventional open surgery in approach-related morbidity. This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring.

Methods  Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion. A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement. The operative duration, blood loss, complications, and fluoroscopic time were recorded. Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index. Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates.

Results  The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively. A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan. Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring. The average fluoroscopy time in each patient was 31.8 seconds, which equals to 7.9 seconds per pedicle screw. No patients had instrument related neurological complications, infection, implant failure or revision. Successful fusion was found in all patients.

Conclusions  The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.

     

Biomechanical change of lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction report of 23 cases

Objective： To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation by X-Tube system. Methods： Five human lumbar cadaveric functional spine units（FSU） were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion （posterior lumbar interbody fusion） and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results： There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 （65.2%）, good in 6 （26.1%） and fair in 2 （8.7%）. The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion： The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgi     

Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model

Background  Computer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.

Methods  Eighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.

Results  The two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P <0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P <0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P >0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P <0.05).

Conclusions  Both bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.

     

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

<正>Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients with     

KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients

Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a relatively high rate of adjacent segment degeneration and screw failure,including screw pullout and breakage.The purpose of this study was to assess the efficacy of open reduction and fixation using KumaFix fixation system in treatment of thoracolumbar burst fractures.Methods From June 2011 to June 2012,45 consecutive patients with thoracolumbar burst fractures were enrolled.They were randomly assigned to treatment with KumaFix （the treatment group,n=23） or traditional U-shaped pedicle screw （the control group,n=22）.The patients were followed up postoperatively and were assessed with regard to radiologic and clinical outcomes.Radiologic outcomes were assessed mainly on the basis of Cobb angle and vertebral wedge angle.Clinical outcomes were evaluated mainly with use of Visual Analog Scale （VAS） for pain and the Oswestry Disability Index （ODI） Questionnaire.Results All patients were followed up from 9 to 22 months.There were no significant differences between the two groups with regard to preoperative indices.The operation time in the treatment group was significantly lower than that in the control group.Preoperative Cobb angles and vertebral wedge angles in two groups were significantly decreased after surgery,and these have been well maintained at the last follow-up with mild correction losses.The results of clinical outcome showed lower VAS and ODI scores in two groups compared with those preoperative,and the treatment group had greater improvement on the ODI compared with the control group at the last follow-up.Conclusions Compared with traditional U-shaped pedicle screw,KumaFix fixation system can achieve gradual,controlled reduction,provide enough space for bone implantation,and avoid acceleration of adjacent segment degeneration.It is an effective and reliable technique to treat thoracolumbar burst fractures.     

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.     

计算机导航技术在脊柱椎弓根钉固定中的应用

目的 探讨术前CT扫描三维虚拟图像导航技术在脊柱椎弓根螺钉固定术中的应用价值.方法 95例行脊柱椎弓根螺钉固定术的患者,随机分为两组,一组在计算机导航技术辅助下植入椎弓根螺钉(导航组),一组采用传统的解剖标志法结合术中透视定位植入椎弓根螺钉(常规组).比较两组间的螺钉钉道准备时间、螺钉位置的优良率和术后并发症的发生率.结果 导航组36例患者共植入椎弓根螺钉206枚,其中优169枚(82.0%)、良29枚(14.1%)、差8枚(3.9%),优良率96.1%.有9例患者因故未能行导航.常规组50例患者共植入椎弓根螺钉285枚,其中优257枚(90.2%)、良28枚(9.8%),无位置差的螺钉,优良率100.0%.两组螺钉优良率间差异无统计学意义(P>0.05).螺钉钉道准备时间导航组为(9360±22)s,常规组为(56±8)s,两组差异有统计学意义(P<0.001).两组患者术后均无并发症发生.结论 术前CT扫描三维虚拟图像导航技术与传统解剖标志定位法植入椎弓根螺钉的精度无明显差异;且延长了手术时间,其在脊柱椎弓根螺钉固定中的应用价值有限.     

SpineNav-01手术导航系统辅助脊柱椎弓根螺钉置入的临床研究

 目的  比较计算机手术导航系统SpineNav-01辅助手术与传统X线透视辅助手术在辅助胸、腰骶椎椎弓根螺钉置入手术中的准确性和安全性,评价该手术导航系统在临床应用中的效果。 方法 纳入33例接受椎弓根螺钉内固定手术的患者,收集临床及影像学资料。按辅助手术方式的不同分成两组:传统组,螺钉置入在X线透视辅助下完成;导航组,螺钉置入在基于术前三维CT数据的手术导航系统辅助下完成。术后三维CT评价两组螺钉的位置情况,比较两组螺钉置入的准确性和安全性,记录每枚螺钉置入时间、置钉相关并发症,导航组另记录注册时间。结果 两组间年龄、性别以及螺钉节段分布情况差异无统计学意义。传统组共置入108枚螺钉,其中胸椎22枚,腰、骶椎86枚,准确率为73.1% (79/108),安全率为96.3% (104/108),出现神经相关并发症2例,1例接受翻修手术;导航组共置入108枚螺钉,其中胸椎30枚,腰、骶椎78枚,准确率为87.0% (94/108),安全率为100% (108/108),出现神经相关并发症1例。两组间螺钉置入准确率及安全率比较,差异有统计学意义 (P<0.05),导航组螺钉置入准确性及安全性优于传统组。传统组每枚螺钉置入时间为2～5 min,平均3.2 min;导航组每枚螺钉置入时间为1～4 min,平均2.2 min;导航组共注册25次,每次注册时间3～9 min,平均4.8 min。 结论 基于术前三维CT数据的SpineNav-01手术导航系统能显著提高胸、腰椎椎弓根螺钉置钉的准确性和安全性。     

计算机辅助影像导航经皮螺钉内固定治疗髋臼骨折的实验研究

目的 确定标准的术中透视图像,作为计算机辅助影像导航经皮螺钉内固定治疗髋臼前、后柱骨折的注册图像.方法 选取干燥尸体骨盆4具、模型骨盆4具作为骨折模型.直视徒手将2.5 mm导针置入髋臼前、后柱(双侧);双侧前柱导针分别采用逆行及顺行置入,后柱导针采用逆行植入;目视确认导针位置满意后,将骨盆固定于影像导航手术模拟操作模块,应用C形臂x线透视机,针对髋臼结构的前、后、外、内4个虚拟平面的垂直方向进行多角度连续动态透视,选择并确认能够清楚显示导针与前后柱、髋臼关节面的透视影像,作为导航手术的注册图像,记录此时c形臂x线透视机与骨盆、手术床的相对空间位置.依此注册图像,在导航手术系统辅助下,应用6.5 mm的钛中空螺钉进行髋臼前、后柱螺钉置入.每个骨折模型,每侧进行1次操作,共16次.目测螺钉位置、分别记录为获取标准注册图像C形臂摆放时间、透视时间、手术操作时间(导航系统建立,软件界面操作及螺钉植入操作的总时间).结果 所有螺钉置入位置满意,未进关节;前柱螺钉置入需要闭孔斜位(Judet-Letoumel斜位)、闭孔人口位、闭孔斜出口位、骨盆正位像;后柱螺钉置入需要髂骨斜位、闭孔斜位、骨盆入口位、闭孔斜出口位像;为获取前柱、后柱标准注册图像摆放C形臂X线透视机的时间平均分别为9.5、7.3 min,前柱、后柱每枚螺钉置入术中透视时间平均分别为2.9、1.7 S,前柱、后柱每枚螺钉置人操作时间平均分别为11.7、9.2 min.结论 导航注册图像不同与传统的Judet-Letoumel影像,如何正确获取标准的术中透视注册图像,是确保安全、准确实施影像导航辅助经皮螺钉内固定手术的关键.     

CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值评估

目的:探讨CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值。方法:通过CT三维重建的多种后处理技术明确寰枢椎病变13例作为观察组,再将CT三维重建、逆向工程原理及快速成形技术相结合,设计出一种新型的导航模板,辅助椎弓根螺钉置入,并与13例之前已通过X线透视置钉法的病例（对照组）进行置钉效果比较。结果:对照组13例共置椎弓根螺钉41枚,其中Ⅰ类置钉9枚,Ⅱ类置钉18枚,Ⅲ类置钉14枚,成功率65.9%;观察组共打印颈椎模型13例,设计导向模板21个,5例由于先前通过X线透视仅在枢椎两侧的椎弓根内置钉,只制作出枢椎的导航模板;模拟手术同样置钉41枚,其中Ⅰ类置钉15枚,Ⅱ类置钉21枚,Ⅲ类置钉5枚,成功率87.8%。结论:CT三维重建的各种后处理技术不仅能够准确的判断寰枢椎病变,并能配合3D打印技术,制作出个体化的导航模板,使上颈椎椎弓根螺钉的置入变得既安全又省时,并能在术后准确评估置钉效果。     

计算机导航辅助下经关节突寰枢关节螺钉治疗齿状突骨折的临床研究

目的 通过比较计算机导航辅助下寰枢关节螺钉置钉方法(导航组)与传统C臂透视指导下寰枢关节螺钉置钉方法（传统组）的临床疗效,评估计算机导航辅助技术在经关节突寰枢关节螺钉治疗齿状突骨折中的临床应用价值。方法 对28例经关节突寰枢关节螺钉后路寰枢融合治疗齿状突骨折患者进行回顾性分析,其中导航组13例,传统组15例,比较两组患者手术时间、透视时间、出血量及术后并发症等情况,术后影像学检查评估两组患者螺钉植入的准确性。结果 28例患者共放置寰枢关节螺钉55枚。平均手术时间导航组154.9min,传统组182.2min,两组差异有统计学意义（P＜0.01),平均透视时间导航组（41.3s）显著少于传统组(64.3s)（P＜0.01)。术后影像学检查显示导航组螺钉位置均满意,传统组中6枚螺钉位置不满意。结论 计算机导航辅助下置入寰枢关节螺钉可以提高手术的安全性和准确性,减少患者和术者射线暴露,缩短手术时间,是治疗齿状突骨折的有效方法。     

腰椎椎弓根导针轴位透视监测的实验研究

目的通过术中对椎弓根多维透视结果进行比较,探索一种简洁易行的透视角度,减少术中椎弓根钉误置率.方法取8具成年人新鲜L1-5椎骨标本,随机建立偏内、偏外、居中3种模型.分别置入导针和椎弓根钉,依次透视侧位、正位、椎弓根轴位、导针轴位、椎弓根钉轴位.根据导针和椎弓根钉与椎弓根投影的相互位置关系判断导针和椎弓根钉位置.术后CT扫描椎弓根钉道,观察椎弓根内外侧皮质穿透情况.切除椎板直视观察结果作为金标准.结果正位透视准确率为34%.侧位透视不能判断偏内及偏外错误.椎弓根轴位透视误将4枚居中判为偏内,准确率为95%.导针轴位透视准确率为100%.结论导针轴位透视能准确判断椎弓根钉导针位置,可提高置钉准确率,减少椎弓根钉松动的人为因素.     

基于C形臂X 光机透视的手术导航系统在椎弓根螺钉植入的应用

目的研究基于C形臂X光机透视的手术导航系统在椎弓根螺钉植入过程中的应用。方法分别使用基于C形臂X光机透视的手术导航技术及传统C形臂X光机透视定位技术,在4具脊柱尸体标本上植入48枚椎弓根螺钉。并进行CT扫描了解椎弓根位置。测量所有螺钉与椎弓根皮质的距离。按照螺钉偏差情况将螺钉位置分为4级。完全位于椎弓根内为A级,破出椎弓根皮质但不超过2mm为B级,破出椎弓根皮质2-4mm为C级,破出椎弓根皮质4mm为D级。结果使用基于C形臂X光机透视的手术导航技术植入的48枚螺钉中,总共有2例螺钉出现偏差。其中1例B级,1例C级。46枚(95.8%)位于椎弓根内,2枚(4.2%)出现偏差,使用传统C形臂X光机透视定位方法植入48枚螺钉,其中有9例破出椎弓根皮质。5例B级,3例C级,1例D级。39枚(81.2%)位于椎弓根内,9枚(18.8%)出现偏差。结论本套导航系统利用普通的C形臂X光机,可以引导椎弓根螺钉准确植入,偏差率很低,并可大大减少X射线辐射。     

机器人辅助置入胸腰椎椎弓根螺钉的临床研究

目的 探讨天玑骨科手术机器人系统辅助下置入胸腰椎椎弓根螺钉的临床效果.方法 将2018年8月-2020年5月于安庆市第一人民医院脊柱外科接受胸腰椎椎弓根螺钉内固定手术的40例患者,根据手术方式分为机器人辅助手术组和"C"形臂透视下徒手组,2组各20例.记录每台手术椎弓根螺钉的置入时间及术中透视次数,根据术后X线和三维C...     

C型臂透视与骨科手术机器人三维成像系统在股骨颈骨折闭合复位内固定术中的应用对比

目的 探讨C型臂透视与骨科手术机器人三维成像系统在股骨颈骨折闭合复位内固定术中的应用比较。方法 收集2021年6月—2021年12月我院45例闭合复位空心钉内固定治疗股骨颈骨折患者的病历资料,包括C型臂透视辅助内固定患者25例(C型臂透视组)及骨科手术机器人三维成像系统辅助内固定患者20例(三维成像组)。分别记录患者性别、年龄、骨折Pauwels分型、受伤至手术时间、手术时间、术中出血量、导针置入次数、术中透续时间、透视次数、后上方螺钉穿出例数、末次随访时疼痛VAS评分、髋关节功能Harris评分及骨折愈合情况等并对两组进行比较。结果 与三维成像组比较,C型臂透视组导针置入次数多、透视时间长、透视次数多、末次随访VAS评分高,后上方螺钉穿出发生率高,而三维成像组手术时间、患者透视次数大于C型臂透视组(P<0.05)。两组术中出血量、髋关节功能比较差异无统计学意义(P>0.05)。两组末次随访时均骨性愈合,无术后并发症。结论 三维成像辅助股骨颈骨折闭合复位内固定置钉精确性高,患者术后疼痛轻,医师接触射线减少,但手术时间较长,且相较于C型臂透视辅助可能使患者吸收更多的X线辐射,...