三维CT导航在腰椎再次手术及翻修术中椎弓根螺钉置入的应用研究(附13例报告)

目的探讨三维CT导航在腰椎再次手术及翻修手术椎弓根螺钉置入中的准确性及安全性。方法回顾性研究自2008年9月~2009年9月,收治因腰椎再次手术及翻修需进行椎弓根螺钉系统内固定13例,其中腰椎间盘术后继发椎管狭窄4例,腰椎置钉失败2例,全椎板或半椎板切除术后腰椎不稳4例、椎体滑脱3例。在减压解除神经根压迫同时在三维CT导航引导下行椎弓根螺钉固定矫形。采用术中G型臂X线机正侧位摄片与导航路径进行比较测量以及术后三维影像系统(CT、MRI)评估螺钉位置的准确性,螺钉完全位于椎弓根内为置钉位置准确,记录螺钉平均置入时间。结果共置入62枚螺钉,术中及术后X线片评估椎弓根螺钉置钉准确度为100%,术后三维影像评估螺钉位置准确率为91.8%,螺钉平均置入时间(4.7±0.7)min/枚,未出现螺钉置入相关的近期并发症。结论腰椎再次手术及翻修手术患者术中应用CT三维影像导航辅助行椎弓根螺钉置入,可以有效的提高置钉的精确性以及保证了安全性,降低了脊柱再次手术及翻修手术的风险性,减少放射线的暴露强度。     

脊柱导航三维影像系统在椎弓根螺钉固定术中的应用

目的：探讨脊柱导航三维影像系统在椎弓根螺钉固定术中的应用效果。方法：49例腰椎间盘突出症伴椎管狭窄症、多节段腰椎管狭窄症伴不稳或退行性侧弯、腰椎滑脱、腰椎爆裂骨折患者分别采用脊柱导航一术中三维影像系统(A组)和传统X线透视法(B组)行椎弓根螺钉固定术，并采用术中三维影像系统评估螺钉位置的精确性；分析比较两组患者螺钉位置、平均螺钉植入时间、手术时间、出血量和近期并发症。结果：A组螺钉位置优良率明显高于B组，平均螺钉植入时间、手术时间、出血量低于B组。A组未发现手术近期并发症。结论：脊柱导航一术中三维影像系统使椎弓根螺钉固定手术更精确、简便、快速和安全，减少术后并发症的发生，为脊柱手术微创化、精确化、安全化发展提供了可靠保证。     

脊柱导航三维影像系统在椎弓根螺钉固定术中的应用

目的:探讨脊柱导航三维影像系统在椎弓根螺钉固定术中的应用效果.方法:49例腰椎间盘突出症伴椎管狭窄症、多节段腰椎管狭窄症伴不稳或退行性侧弯、腰椎滑脱、腰椎爆裂骨折患者分别采用脊柱导航-术中三维影像系统(A组)和传统X线透视法(B组)行椎弓根螺钉固定术,并采用术中三维影像系统评估螺钉位置的精确性;分析比较两组患者螺钉位置、平均螺钉植入时间、手术时间、出血量和近期并发症.结果:A组螺钉位置优良率明显高于B组,平均螺钉植入时间、手术时间、出血量低于B组.A组未发现手术近期并发症.结论:脊柱导航-术中三维影像系统使椎弓根螺钉固定手术更精确、简便、快速和安全,减少术后并发症的发生,为脊柱手术微创化、精确化、安全化发展提供了可靠保证.     

术中三维导航引导下脊柱侧凸的椎弓根螺钉置入研究

[目的]探讨术中实施三维导航在脊柱侧凸病人椎弓根螺钉置入的应用价值.[方法] 38例脊柱侧凸病人行三维导航引导下椎弓根螺钉固定术,其中青少年特发性脊柱侧凸18例,老年退行性脊柱侧凸20例.手术中脊柱CT三维扫描后向导航系统输入患者信息资料,用导航棒按导航指引下在最佳位置、直径和长度立体、动态地置入椎弓根螺钉.[结果]三维导航引导下成功对38例脊柱侧凸病人共置入236枚椎弓根螺钉,复查X线片和CT,无螺钉松动和断裂,按分类法:A级227枚,B级7枚,C级2枚,D级0枚.术后侧凸平均26°(21°～118°),矫正率(61％);术后后凸平均14°(5°～29°),矫正率39％.38例平均随访18个月(12 ～25个月),术后无脊髓或神经根损伤.[结论]三维导航引导下的脊柱侧凸椎弓根钉置入方法精确可靠.     

上下邻椎及骨折椎椎弓根螺钉固定治疗胸腰椎单椎爆裂性骨折

目的探讨采用3椎6钉固定骨折椎及上下邻椎治疗胸腰椎单椎体爆裂性骨折的疗效。方法上下邻椎及骨折椎固定治疗胸腰椎单椎体爆裂性骨折37例,先植入骨折椎的上下邻椎椎弓根螺钉,后植入骨折椎椎弓根螺钉,椎弓根螺钉锁固定在连接棒上,撑开使椎体高度恢复,植骨融合。结果37例均获随访,时间6～36（17.3±8.2）个月,骨折椎椎体高度恢复至85%～100%（95.9%±8.2%）;术后矢状面Cobb角2°～8°（3.2°±1.3°）。术后12个月取出内固定25例,未发现椎弓根螺钉断裂,随访24个月时,Cobb角为2°～17°（7°±2.8°）。末次随访时脊髓功能明显改善。结论骨折椎体置入椎弓根螺钉,可提高复位质量,改善固定强度及应力分布,增强脊柱稳定性,是治疗胸腰椎单椎爆裂性骨折安全可靠的方法。     

计算机导航系统在椎弓根螺钉固定中的应用

目的对计算机导航三维影像系统在脊柱椎弓根螺钉固定术中的应用效果进行评价。方法17例患者采用计算机导航三维影像系统行椎弓根螺钉固定术，并采用术中三维影像系统评估螺钉位置的精确性，术后应用CT做椎弓根扫描，分析椎弓根钉位置的优良率。结果螺钉位置优良率高，无误植和近期并发症发生。结论计算机导航三维影像系统使椎弓根螺钉固定手术更精确、更安全，为脊柱手术精确化、微创化提供了可靠的保证。     

骨科手术导航系统在椎弓根螺钉固定术中的应用

目的: 探讨骨科导航系统在脊柱椎弓根螺钉固定术的应用价值。方法: 同期行椎弓根螺钉固定术患者 44例 (男 26例,女 18例, 共 230枚椎弓根螺钉), 其中应用骨科手术导航系统及未应用该系统各 22例, 术后均进行置入螺钉节段的X线平片确定螺钉置入情况。结果: 应用骨科手术导航系统置入椎弓根螺钉无 1例出现早期并发症, 107 /116枚螺钉置入位置准确, 与对照组相比有显著性差异 (X2 =9. 17,P<0. 01)。结论: 应用骨科手术导航系统可保证螺钉置入位置的准确性, 降低手术相关并发症及避免放射线损害, 特别是对于椎弓根变异如脊柱侧凸、后凸畸形及严重脊柱退变有明显优越性。     

青少年脊柱侧凸患者胸椎椎弓根螺钉置入的准确性和安全性评价

目的：探讨青少年脊柱侧凸患者胸椎椎弓根螺钉置入的准确性和安全性，以减少相关手术并发症。方法：32例青少年脊柱侧凸患者术前均对畸形脊柱进行标准俯卧位CT加密扫描，测量进钉点至椎体前缘的深度、进针角度、椎弓根直径和椎体的旋转角度，根据测得数据确定椎弓根螺钉置入的深度和方向，置入螺钉后再行脊柱全长X线片及CT扫描评价置钉的准确性和安全性。结果：32例共置入226枚胸椎椎弓根螺钉，术后CT加密和X线片观察到205枚螺钉（90．7％）完全在椎弓根皮质骨内。10例21枚螺钉（9.3％）发生错置，7枚螺钉（3．1％）偏外，5枚螺钉（2．2％）偏前外侧（其中2枚螺钉靠近节段血管），4枚螺钉（1．8％）偏下，4枚螺钉（1．8％）直径过大导致椎弓根内壁膨胀内移，1枚螺钉（0．4％）误入椎管导致完全性脊髓损伤。T1～T4错置12枚（18．2％），T5～T12错置9枚（6．1％）；凸侧椎根螺钉置入的准确率为93．8％，凹侧为83．1％。结论：脊柱畸形患者术前应常规采用标准俯卧位CT加密扫描，根据扫描图像测得的相关数据可为术中准确置入椎弓根螺钉提供重要参考依据。在青少年脊柱侧凸患者胸椎椎弓根螺钉置入有一定的误置率，螺钉发生错置多见于上胸椎和凹侧．术中应高度重视。     

多节段椎弓根螺钉内固定系统矫正胸椎侧凸畸形的有效性和安全性评价

目的:评价多节段椎弓根螺钉内固定系统矫正胸椎侧凸畸形的有效性和安全性。方法:回顾我院1994年3月～2002年3月应用椎弓根钉-棒系统矫治的118例胸椎侧凸畸形患者的临床资料,分析评价其手术并发症、侧凸矫正率及长期随访结果。结果:胸椎椎弓根总计置入螺钉916枚,术中及术后螺钉松动16枚;螺钉位置不良12枚;椎弓根骨折7例;脑脊液漏3例;1例术后螺钉松动压迫脊髓。术后平均随访5年,脊柱侧凸畸形平均矫正率为75%,平均矫正度丢失率1.2%,1例出现交界性后凸再次手术治疗。结论:多节段椎弓根螺钉内固定系统是矫正脊柱侧凸畸形一种较安全、有效的三维内固定方式。     

导航辅助腰椎椎弓根螺钉置入的误差分析

目的：探讨导航辅助腰椎椎弓根螺钉置入的准确性和误差产生的原因。方法：16例腰椎疾病的患者，在导航辅助下置人76枚椎弓根螺钉，手术后行X线和CT检查，在矢状位测量螺钉与椎弓根上缘的相对位置、与椎体上缘的角度；横断位测量螺钉与椎弓根内壁的相对位置、与椎体中线的角度。并与手术导航图像的对应数值进行统计学比较。结果：有2枚螺钉偏头侧出椎弓根，术中纠正，1枚螺钉造成椎弓根外壁缺损而被取出，2枚螺钉偏外侧出椎弓根。其余螺钉手术后CT与手术中导航图像显示的位置角度比较没有显著性差异。导航可能产生两种偏差，一种是因为椎体之间的距离缩短，常见于腰椎骨折和腰椎不稳定的患者，手术过程中腰椎前凸加大，螺钉出椎弓根上缘或下缘；另一种是扩椎弓根时图像晃动，或者开路锥在椎弓根内调整位置时产生的虚假图像误导手术者判断错误。结论：在使用导航过程中要采取措施避免腰椎的前凸加大，根据静止的图像做出判断，以减小误差。     

Intra-operative spinal sonography in spinal intramedullary tumor

Recently, operative results of intramedullary spinal cord tumors have been greatly improved since the introduction of microsurgery. It is very important to know the precise size and location of the tumor prior to the operation so that we can approach the tumor with a minimum of damage to the spinal cord. However, it is not always possible to demonstrate the precise localization of the tumor preoperatively. In this report, we emphasize that intraoperative spinal sonography is very useful in determining the extent of the tumor and differentiating solid component from cystic component of the tumor. Methods and Materials We performed intraoperative spinal sonography on ten patients with intramedullary spinal cord tumor. This series included three cases of hemangioblastoma, three cases of astrocytoma, two cases of ependymoma, one case of subependymoma, and one case of mixed glioma. Eight out of ten cases were associated with cysts. The intraoperative spinal sonographic examinations were performed after laminectomy. The linear scanning probe of 5 or 7.5 MHz transducer was used. Results 1) Solid components The acoustic pattern of the solid tumor was either hyperechoic or iso-echoic. Six cases (three hemangioblastomas, two ependymomas, and one astrocytoma) were hyperechoic. Other four cases (two astrocytomas, one subependymoma, and one mixed glioma) were iso-echoic. 2) Cystic components The cysts associated with the tumor were anechoic in six out of eight cases, which were confirmed at surgery, and multiple cysts were identified.(ABSTRACT TRUNCATED AT 250 WORDS)     

Segmental spinal instrumentation for neuromuscular spinal deformity

Seventy-six consecutive surgical cases of paralytic neuromuscular spinal deformity were retrospectively analyzed. Posterior arthrodesis with segmental spinal stabilization with Luque L-rods, sometimes preceded by anterior release, was done in all cases. The infection rate of 14.5% was observed to be markedly higher in patients with myelodysplasia. Deep placement of the rods lateral to the spine and well beneath full-thickness skin is recommended to reduce the incidence of this complication.     

Rationale for spinal fusion in lumbar spinal stenosis

In order to define the indications for spinal fusion in patients undergoing decompression for lumbar spinal stenosis, 114 patients surgically treated were reviewed. Follow-up was 24 to 108 months. Patients were grouped into four categories: 15 with lateral recess stenosis, 45 with central-mixed stenosis, 43 with stenosis following prior lumbar surgery(s), and 11 with scoliosis and spinal stenosis. Only two patients with lateral recess stenosis underwent fusion with fair results. Approximately one-third of those with central-mixed stenosis required a fusion. Results were good in 70%. In those with stenosis following prior lumbar surgeries, although not statistically significant, those who had concomitant decompression and arthrodesis had a better outcome than those in whom decompression only was done. Patients with scoliosis and stenosis had decompression for significant motor and reflex deficits and fusion over the length of their major curves. Patients having decompression for lumbar stenosis with degenerative spondylolisthesis, isolated disc resorption with degenerative facet joints, intervertebral disc disease with instability, and those with scoliosis with multidirectional instabilities benefit from concomitant spinal fusion.