Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures: Results from the German Pelvic Trauma Registry

Background

Percutaneous iliosacral screw placement following pelvic trauma is a very demanding technique involving a high rate of screw malpositions possibly associated with the risk of neurological damage or inadequate stability. In the conventional technique, the screw's correct entry point and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools.The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications.

Methods

This study is based on data from the prospective pelvic trauma registry introduced by the German Society of Traumatology and the German Section of the AO/ASIF International in 1991. The registry provides data on all patients with pelvic fractures treated between July 2008 and June 2011 at any one of the 23 Level I trauma centres contributing to the registry.

Results

A total of 2615 patients were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187 × with surgical interventions) and 597 patients with sacral fractures (334 × with surgical interventions).The rate of intraoperative complications was not significantly different, with 10/114 patients undergoing navigated techniques (8.8%) and 14/239 patients in the conventional group (5.9%) for percutaneous screw implantation (p = 0.4242).Postoperative complications were analysed in 30/114 patients in the navigated group (26.3%) and in 70/239 patients (29.3%) in the conventional group (p = 0.6542). Patients who underwent no surgery had with 66/197 cases (33.5%) a relatively high rate of complications during their hospital stay. The rate of surgically-treated fractures was higher in the group with more unstable Type-C fractures, but the fracture classification had no significant influence on the rate of complications.

Discussion

In this prospective multicentre study, the 2D/3D navigation techniques revealed similar results for the rate of intraoperative and postoperative complications compared to the conventional technique. The rate of neurological complications was significantly higher in the navigated group.     

3D打印导航模板引导双侧下颈椎前路椎弓根螺钉置钉的可行性

目的 :通过3D打印技术及骨科数字化技术制作下颈椎前路椎弓根螺钉置钉导航模板,观察模板辅助下置钉的准确性。方法:选取正常成人颈椎湿性标本10具(男、女各5具),将椎前软组织剔除,采用64排薄层CT扫描后获取其DICOM格式数据,导入Mimics软件后三维建模并为颈前路椎弓根螺钉选取理想钉道,设计建立螺钉导航模板后导出其STL数据,通过3D打印机快速打印成型。在导航导板引导下进行下颈椎前路椎弓根螺钉置钉,通过X线及CT评价螺钉的准确性。结果:10具尸体分别于C3~T1每节段置入2枚螺钉,共计120枚,根据螺钉的位置将其分为4级:0级,螺钉完全在椎弓根内,共115枚;1级,螺钉穿破椎弓根皮质,穿出部分小于螺钉直径的25%,1枚;2级,螺钉穿破椎弓根皮质,穿出部分为螺钉直径的25%~50%,3枚;3级,螺钉穿出椎弓根部分大于螺钉直径的50%,1枚。5枚穿破椎弓根皮质者2枚穿破椎弓根内侧皮质,3枚穿破外侧皮质,总体准确性为95.8%。结论:在湿性尸体颈椎标本上应用3D打印及骨科数字化技术制作的导航模板辅助行下颈椎前路椎弓根螺钉置钉的准确性高,为临床应用提供了依据。     

三维打印个体化导航模板在枕骨髁螺钉固定技术中的应用研究

【摘要】 目的：探讨一种基于三维打印技术制备个体化枕骨髁螺钉导航模板的可行性,并对该方法辅助置钉的准确性和安全性进行评估。方法：选取20具成人尸体的枕颈部标本,将其CT扫描数据导入Mimics软件,对枕骨至枢椎水平行选择性三维重建,观察并测量枕骨髁相关解剖结构以确定置钉参数。在计算机三维模型上虚拟枕骨髁螺钉钉道及其导向通道,设计与枕骨后部结构相贴合的阴模,将阴模与导向通道整合后利用三维打印技术成型,制作出枕骨髁模型及对应的个体化导航模板。然后导航模板辅助下分别于模型和尸体标本置入双侧枕骨髁螺钉,并通过解剖观察及CT扫描评估置钉准确性。结果：枕骨髁的大体形态及毗邻解剖结构个体差异较大,虚拟置钉后测得置钉轴位内倾角、矢状位倾角和进钉点至寰枕关节面的垂直距离分别为30.2°±6.3°、8.1°±2.6°和3.69±0.42mm。根据置钉参数设计并打印出20个枕骨髁模型及对应的个体化导航模板,在其辅助下成功置入双侧枕骨髁螺钉共40枚,置钉耗时（60.1±9.3）s。术后解剖观察及CT扫描提示所有螺钉均准确置入枕骨髁内。结论：使用Mimics软件能够根据CT扫描结果利用三维打印技术制作出个体化枕骨髁螺钉导航模板,辅助置钉准确性高,操作简单,为枕骨髁螺钉的精确置入提供了新思路。     

导航系统辅助下颈椎椎弓根螺钉置钉准确性的实验研究

目的：评价导航系统辅助下颈椎（C3～C7）椎弓根螺钉内固定置钉的准确性.方法：将32具成人尸体颈椎标本随机分为4组,分别采用盲法、透视法、透视导航法和CT导航法进行下颈椎椎弓根螺钉置入.术后采用标本大体解剖观察的方法评价置钉准确性.分优（螺钉完全在椎弓根内）、可（仅有螺纹穿出,对周围组织无损伤）和差（螺钉明显穿出）进行统计.结果：共置入螺钉318枚.盲法80枚,平均手术时间27min,优29枚（36 3%）、可21枚（26.3%）、差30枚（37.5%）;透视法78枚（有1例C4、C5右侧椎弓根均细小,不能容纳3.5mm螺钉）,平均手术时间112min,优35枚（44.9%）、可29枚（37.2%）、差14枚（17.9%）;透视导航法80枚,平均手术时间69min,优34枚（42.5%）,可36枚（45%）,差10枚（12.5%）;CT导航法80枚,平均手术时间98min,优70枚（87.5%）、可10枚（12.5%）.各组间手术时间均有显著性差异（P＜0.05）,透视法与透视导航法的置钉准确率间无显著性差异,其余各组间均有显著性差异（P＜0.05）.结论：单纯根据术前影像结果盲法行下颈椎椎弓根螺钉内固定不安全.透视法和透视导航法可提高置钉准确性,但手术风险仍较大,透视导航法比透视法置钉的手术时间缩短.CT导航法并未比透视法增加手术时间,但置钉准确性显著提高.     

3D打印椎弓根导航模板在下颈椎椎弓根置钉中的临床应用

【摘要】 目的：探讨采用优化设计的3D打印椎弓根导航模板辅助下颈椎椎弓根螺钉置入的安全性和准确性。方法：回顾性分析2016年8月~2022年10月在我科行颈椎后路椎弓根螺钉内固定手术的患者42例,年龄32~74岁（50.1±9.8岁）,随访13~25个月（19.6±3.2个月）。根据置钉方式分为导板组（n=22）和徒手组（n=20）：导板组采用优化的椎弓根钻孔导航模板设计方案,3D打印制作下颈椎椎弓根导航模板辅助椎弓根置钉,其中男性12例,女性10例,颈椎损伤或颈脊髓损伤6例,后纵韧带骨化症（OPLL）9例,颈椎管肿瘤5例,脊髓型颈椎病2例;徒手组根据术前颈椎CT测量椎弓根角度、直径等参数,采用徒手置钉,其中男、女各10例,颈椎损伤或颈脊髓损伤4例,OPLL 10例,颈椎管肿瘤5例,脊髓型颈椎病1例。两组患者性别构成、年龄、诊断、术前VAS评分、JOA评分比较无统计学差异（P>0.05）。记录两组患者手术时间、术中出血量;术后1周颈椎CT扫描,按照Kaneyama方法评估椎弓根置钉的准确性：0级,螺钉完全位于椎弓根内;1级,穿破椎弓根的部分<螺钉直径的50%;2级,穿破椎弓根的部分>螺钉直径的50%;3级,椎弓根螺钉完全位于椎弓根外。0级或1级定义为椎弓根置钉准确,2级或3级为螺钉误置。记录患者的围手术期并发症,统计并比较两组术后12个月疼痛视觉模拟评分（VAS）、日本骨科学会（JOA）评分。结果：42例患者手术顺利,导板组手术时间102.2±16.1min,术中出血量89.3±17.7mL;均少于徒手组142.8±20.9min,133.3±34.0mL（P<0.01）。42例患者共置入下颈椎椎弓根螺钉216枚：导板组118枚,其中0级90枚,1级22枚,2级5枚,3级1枚,置钉准确率94.9%（112/118）;徒手组98枚,其中0级48枚,1级36枚,2级10枚,3级4枚,置钉准确率85.7%（84/98）。导板组置钉准确率显著性高于徒手组（P<0.05）。两组患者均未出现螺钉相关神经血管损伤,无内固定松动断裂并发症,术后12个月VAS评分较术前显著性降低（P<0.01）,JOA评分较术前显著性提高（P<0.01）,两组间比较无显著性差异（P>0.05）。结论：3D打印椎弓根导航模板的优化设计方案有助于提高下颈椎椎弓根置钉的准确性。     

快速成形3D导板辅助下置入下颈椎前路椎弓根螺钉与徒手置钉的对比研究

目的:比较快速成形3D导板辅助下和徒手置入下颈椎前路椎弓根螺钉的位置差异,评价两种置钉方法的安全性.方法:8具甲醛浸泡后的成人下颈椎尸体标本,男4具,女4具;年龄32～65(40.3±5.6)岁,行X线片检查排除骨质破坏和畸形后,随机选取其中4具(3D导板组)行CT扫描后获得DICOM格式数据,导入Mimics软件建模...     

快速成型导航模板辅助颈椎螺钉置入的研究进展

颈椎螺钉内固定技术凭借其高融合率、手术节段即刻固定及良好的矫形能力在临床上得到广泛应用。但由于解剖结构变异、椎弓根较细等原因,采用传统方法置钉难度较大,螺钉穿孔率较高,可引起神经血管损伤等严重并发症。近年来快速成型导航模板被报道应用于辅助颈椎螺钉置入,以提高螺钉置入的准确性。本文通过回顾及总结近20年来已发表关于导航模板辅助颈椎螺钉置入相关文献,系统介绍了导航模板的制作与使用方法、设计理念发展历程以及在颈椎手术中的应用现状。目前相关临床及尸体研究证实在颈椎手术中,使用快速成型导航模板辅助颈椎螺钉置入可降低螺钉穿孔率、术中电离辐射伤害及手术时间,值得在临床工作中推广应用。但是不同设计类型的导航模板的具体临床疗效没有很高的总结。因此,更多比较不同设计类型导航模板准确性与安全性的尸体及临床试验急需进行,以帮助临床医生选择合适的导航模板进行手术。     

Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment

Study design  Postoperative outcomes of segmental pedicle screw fixation were evaluated in posterior scoliosis surgery with the use of navigation system. Objectives  We report the usefulness of a navigation system and a segmental pedicle screw fixation in surgery for scoliosis. Summary of background data  Few reports on a segmental pedicle screw fixation method for scoliosis surgery using a navigation system have been published. This is the report on the usefulness of a navigation system in segmental pedicle screw fixation. Methods  We targeted 16 cases in which segmental pedicle screw fixation had been performed using a navigation system at our hospital. We inserted 264 pedicle screws in total, and we did not perform registration for each corpus vertebrate in order to shorten the duration of the surgery. We reviewed screw deviation among the items for review using Neo classification with postoperative CT images (1.25 mm). For screw deviation in this case, grade 2 or higher in the Neo classification system was designated as total deviation. Furthermore, we evaluated the registration period per corpus vertebrae, the complications, duration of surgery, blood loss, Cobb angle, and the correction rate. Results  In terms of screw deviation, 11 (4.2%) of the 264 inserted screws were classified as total deviation. However, there were no neurovascular complications during or after surgery in any cases, and all cases maintained strong internal fixation. In the relationship between the use or nonuse of registration and the deviation, four screws (3.2%) in the corpus vertebrae for which registration was performed and seven screws (5.0%) in the adjacent corpus vertebrae for which registration was not performed had deviated. The duration of registration per corpus vertebrate averaged 4 min and 24 s (58–791 s), but registration also requires a learning curve, so the duration of registration per corpus vertebrae averaged 1 min and 14 s in more recent cases, thus marking a significant shortening. Conclusion  Segmental pedicle screw fixation are excellent in regard to their fixing and correction force and have been clinically applied even in surgery for scoliosis, but the potential risk of neurovascular complications is unavoidable. The adoption of a navigation system in surgery for scoliosis is useful to increase the safety and certainty of the insertion of pedicle screws.     

O-arm导航、3D打印导板及C型臂X线机辅助下寰枢椎螺钉置入的准确性比较

目的：对比分析O-arm导航、个体化3D打印导板、C型臂X线机辅助下置入寰椎侧块螺钉和枢椎椎弓根螺钉的准确性和安全性。方法：回顾性分析2015年1月～2020年12月在我院行寰枢椎内固定术患者的临床资料,根据纳入和排除标准,共纳入47例患者,男28例,女19例;年龄15～59岁（46.2±10.0岁）。根据置入寰枢椎螺钉方式的不同,分为导航组（应用O-arm导航辅助下置钉,11例）、导板组（应用3D打印导板指导下置钉,15例）、透视组（依据解剖标志在C型臂X线机透视辅助下徒手置钉,21例）。统计三组的手术时间、置钉时间、术中出血量、一次性置钉成功率、螺钉置入精准性及并发症。结果：导航组手术时间、置钉时间和出血量分别为120.7±11.1min、20.0±1.1min和225.8±25.6ml;导板组分别为97.5±9.0min、15.8±1.9min和162.7±18.5ml;透视组分别为121.0±12.8min、19.4±2.1min和239.0±24.5ml,导板组手术时间、置钉时间、出血量少于其他两组（P<0.05）。共置入寰枢椎螺钉188枚,导航组44枚、导板组60枚、...     

Optimal cervical screw insertion angle determined by means of computed tomography scans pre- and postoperatively

Background Context

Cervical pedicle screw (CPS) insertion is technically demanding and carries a risk of serious neurovascular complications when screws perforate. To avoid such serious risks, we currently perform CPS insertion using a computed tomography (CT)-guided navigation system. However, there remains a low probability of screw perforation during CPS insertion that is affected by factors such as CPS insertion angle and anatomical pedicle transverse angle (PTA).

透视及导航下颈椎椎弓根螺钉内固定术的临床应用经验

目的　报告使用透视下及无线主动式红外诱导计算机导航引导下进行颈椎椎弓根钉固定手术的经验 ,分析手术成功的要素。方法　自 2 0 0 1年 10月至 2 0 0 2年 12月共行颈椎椎弓根螺钉 -AXIS钛板内固定 2 9例 ,男性 18例 ,女性 11例。年龄 2 6岁～ 76岁 ,平均年龄 4 9.4岁。使用C形臂X线透视下螺钉置入 2 5例 ,无线主动式红外诱导计算机导航下椎弓根内固定 4例。共置入椎弓根螺钉 174枚。结果　 174枚螺钉中有 15 5枚 (89% )位置正确。 19枚螺钉存在不同程度的偏差 ,均为内倾不够 ,1例出现一过性神经根合并症。计算机导航置入螺钉 2 4枚 ,位置正确率 10 0 %。术前颈椎后凸者固定节段曲度平均- 12 .1°术后平均 - 0 .6° ,明显得到纠正。术后 3个月和 6个月的随诊 ,颈椎曲度和固定节段椎体高度均维持 ,没有出现内固定物松动 ,螺钉断裂等情况。结论　颈椎椎弓根钉固定手术是颈椎获得牢固固定的方法 ,为颈椎后路手术提供了更广的操作空间 ,免去部分同时前路手术的需要 ,而且可以用于颈椎后凸的矫正。但是结构的复杂性和变异性及周围的神经血管使手术难度加大 ,在透视下可以比较安全地置入螺钉 ,更好的方法是使用计算机导航技术。这一技术具有良好的临床应用前景。     

Iso-C 3D导航系统下椎弓根钉内固定治疗颈椎骨折脱位

[目的]探讨在Iso-C 3D导航系统下行椎弓根螺钉内固定治疗颈椎骨折、脱位的临床意义。[方法]在Iso-C 3D导航系统下,应用椎弓根螺钉内固定治疗颈椎骨折、脱位共31例,观察临床疗效及置钉的准确性。[结果]本组31例中,共置入136枚椎弓根螺钉。术后X线片显示,颈椎骨折脱位复位均满意,颈椎生理曲度恢复良好。术后CT显示,136枚椎弓根螺钉中,有6枚螺钉穿破椎弓根,穿透皮质率4.4%,但均未造成脊髓、神经、血管压迫等。经随访,X线显示所有病例融合区均骨性愈合,无1例出现断钉及内置物松动现象。合并脊髓损伤的患者,术后神经功能均有不同程度的恢复。[结论]椎弓根螺钉技术稳定性良好,具有优越的生物力学性能,为颈椎骨折脱位行后路内固定提供了一种安全有效的方法,在Iso-C 3D导航下行颈椎椎弓根螺钉内固定手术,能显著提高椎弓根螺钉置入的准确性和安全性。     

Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room

IntroductionIn recent years hybrid operating rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a hybrid operating room increases the accuracy of SI-screws in comparison to standard 3D-navigation.Material and methodsRetrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the hybrid operating room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS.Results65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference (p < 0.001). Twenty patients could be included in group 2. Eleven screws showed a complete intraosseous position. There was grade 1 perforation in 2 screws, grade 2 perforation in 5 screws and grade 3 perforation in 2 screws.ConclusionImprovements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a hybrid operating room. Furthermore difficult tasks like a single screw for both joints can be accomplished.     

导航模板辅助脊柱椎弓根内固定术与传统椎弓根内固定术手术效果比较的Meta分析

目的:系统评价快速成型导航模板辅助脊柱椎弓根内固定术与传统通过解剖标志定位的内固定术的优良率与疗效。方法:计算机检索2017年6月前PubMed、The Cochrane Library(2017年5期)、Clinical Trial、Google Scholar、Web of Science、中国知网(CNKI)、万方(Wanfang Data)和维普(VIP)等中英文数据库,查找有关于导航模板辅助脊柱椎弓根螺钉置入与传统置入术临床疗效对比的临床随机对照试验(RCT)和前瞻性病例对照研究或回顾性病例对照研究。由2位研究者分别根据纳入与排除标准进行文献筛选、数据提取,通过Cochrane Handbook对纳入的随机对照试验进行方法学质量评价,通过NOS量表对纳入的前瞻性病例对照研究和回顾性病例对照研究进行方法学质量评价,采用Cochrane协作网RevMan 5.3软件对两种椎弓根螺钉置入方式所得疗效指标进行Meta分析。结果:最终共纳入7篇文献,包括2篇RCT、1篇前瞻性病例对照研究和4篇回顾性病例对照研究,共计237例患者,置入椎弓根螺钉1 688枚,其中导航模板组898枚螺钉,传统手术组790枚螺钉。Meta分析结果显示:导航模板组与传统手术组在螺钉置入优良率的差异有统计学意义[OR=5.05,95%CI(3.13,8.16),P0.000 01];两组胸腰段手术时间存在差异,且差异具有统计学意义[WMD=-27.19,95%CI(-38.21,-16.17),P0.000 01];两组术中出血量存在差异,且差异有统计学差异[WMD=-100.82,95%CI(-182.26,-19.37),P=0.02]。结论:导航模板脊柱椎弓根螺钉内固定术与传统椎弓根螺钉内固定术相比具有更好的临床疗效,可以提高螺钉置入的优良率,减少手术时间及术中出血量。     

术中导航校准技术辅助下青少年特发性脊柱侧凸顶椎区置钉精确性研究

【摘要】 目的：比较青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）顶椎区相同椎弓根类型在导航及导航校准技术辅助下置钉的精确性及偏出方向,并分析影响导航置钉偏移的相关因素及导航校准技术的临床意义。方法：回顾性分析自2017年10月～2020年10月,在我院明确诊断为AIS并在导航辅助下行经后路脊柱侧凸矫形内固定术治疗的41例患者,依据术中是否使用导航校准技术,将41例患者分为两组：导航组（n=22）和校准组（n=19）。收集两组患者基本信息,记录两组患者Risser征,术前、术后Cobb角,术后1年时矫形率,根据付长峰椎弓根分型系统对两组患者顶椎区椎弓根分型（A、B、C、D、E型）,依据Rao分型评估两组相同椎弓根类型的置钉精确性。结果：校准组A、B、C型椎弓根优良置钉率（96.4%、87.8%、84.0%）显著高于导航组（79.2%、70.5%、56.7%）,且凹凸双侧0级钉率显著高于导航组,同时校准组B型椎弓根及其凹凸双侧3级钉率（4.1%、2.0%、6.3%）及C型椎弓根凸侧2级钉置钉率（11.1%）显著低于导航组（12.4%、11.1%、13.7%、50.0%）,两组间差异均具有统计学意义（P＜0.05）。此外,校准组A、B、C型椎弓根外侧皮质破壁率（33.3%、33.3%、60.0%）显著低于导航组（64.0%、38.6%、73.1%）,同时校准组A型椎弓根椎体前壁穿破率（0.0%）及C型椎弓根凹侧外侧皮质破壁率（66.7%）显著低于导航组（24.0%、77.8%）,而B型椎弓根内侧皮质穿破率（41.7%）高于导航组（40.9%）,但其凹侧内侧皮质穿破率（36.4%）显著低于导航组（33.3%）,两组间差异均具有统计学意义（P＜0.05）。两组间均未发生脊髓、神经血管损伤等严重并发症。结论：与传统导航相比,导航校准技术在术中能够有效地预防导航偏移,显著提高AIS顶椎区A、B、C型椎弓根置钉精确性,降低误置螺钉外侧壁穿孔率及B型椎弓根凹侧内侧壁穿孔率,提高手术的安全性。     

O型臂3D导航与徒手置钉在上颈椎椎弓根螺钉置入中的精确性比较

目的 :比较O型臂3D导航下C1、C2椎弓根螺钉置钉与徒手置钉精确性的差异,探讨O型臂导航在上颈椎椎弓根螺钉置钉中的应用价值。方法:纳入我院C1、C2椎弓根螺钉内固定患者62例,分为导航置钉组(A组)与徒手置钉组(B组)。A组:2014年1月~2015年3月,O型臂导航下行C1、C2后路椎弓根螺钉内固定术22例,男15例,女7例,年龄17~58岁(40.8±12.7岁);B组:2005年3月~2013年12月经徒手置入C1及C2椎弓根螺钉患者40例,男26例,女14例,年龄12~70岁(42.0±15.6岁)。所有患者术后均行颈椎CT平扫,按照Neo等的方法,根据椎弓根螺钉穿破椎弓根皮质的程度将置钉精确性分为四级(0级,螺钉完全处于椎弓根中,没有穿破骨皮质;1级,螺钉穿破皮质2mm,或小于螺钉直径的50%;2级,螺钉穿破皮质≥2mm且﹤4mm,或大于螺钉直径的50%但没完全穿出;3级,完全穿出皮质,螺钉处于椎管或椎动脉孔内),分别评估两组的置钉精确性并比较两组间的差异。结果:A组共置入C1、C2椎弓根螺钉67枚(C1 28枚,C2 39枚),其中0级60枚(89.6%),1级7枚(10.4%),无2级或3级不良置钉;B组共置入C1、C2椎弓根螺钉134枚(C1 64枚,C2 70枚),其中0级116枚(86.6%),1级13枚(9.7%),2级4枚(3.0%),3级1枚(0.7%)。两组间置钉精确性分级(P=0.49)及0级置钉率(P=0.55)均无统计学差异;A组未发现不良置钉,B组不良置钉发生率为3.7%,但组间无统计学差异(P=0.17)。两组均无置钉相关的血管、神经并发症发生。结论:术中O型臂导航与徒手置钉在上颈椎椎弓根螺钉置钉精确性上并无统计学差异,虽然导航能提供清晰的术中3D图像,但该技术未能完全避免置钉时螺钉轻度穿破骨皮质的发生,仍需提高术者与导航系统间的交互作用,完善操作技术,进一步提高置钉精确性。     

The correlation between cervical range of motion and misplacement of cervical pedicle screws during cervical posterior spinal fixation surgery using a CT-based navigation system

Purpose

The aim of this study was to analyze the correlation between cervical range of motion and cervical pedicle screw (CPS) misplacement in cervical posterior spinal fusion surgery using a CT-based navigation system.

Methods

A total of 46 consecutive patients with cervical posterior spinal fusion surgery using CPSs were evaluated retrospectively. We analyzed the cervical range of motion (ROM) and the misplacement of CPSs that were placed using either separate or single-time multilevel registration with a CT-based navigation system to determine the optimum registration procedure. The screw-inserted vertebra was indicated as Registered vertebra-Pedicle Screw inserted vertebra (Re-PS) = 0, 1, 2, or 3 depending on its distance (level) from the registered vertebra. Grades 0 (no perforation) and 1 (perforations <2 mm) were categorized as “no misplacement.” Grades 2 (perforations ≧2 mm but < 4 mm) and 3 (perforations ≧ 4mm) were categorized as “misplacement.” We analyzed the correlations between CPS misplacement and Re-PS, and between CPS misplacement and preoperative cervical ROM.

Results

Our analysis included 196 screws in patients having a mean age of 53.2 years (range 5–84 years). Level of insertion relative to registration was Re-PS = 0 in 129 screws, Re-PS = 1 in 53, Re-PS = 2 in 10 and Re-PS = 3 in 4. The misplacement rates were 12.2 % (24 screws) overall, 6.2 % in Re-PS = 0, 22.6 % in Re-PS = 1, 20 % in Re-PS = 2, and 50 % in Re-PS = 3. The rate of CPS misplacement increased significantly with a Re-PS = 1 and a Re-PS = 2 and 3 compared to a Re-PS = 0. There was a significant difference in the cervical ROM in each grade and both misplacement groups: 1.8 in Grade 0, 2.3 in Grade 1, 7.8 in Grade 2, 12.9 in Grade 3, 11 in the misplacement group and 1.9 in the no misplacement group.

Conclusions

The precision of CPS placement in CT-based navigation surgery was evaluated. The misplacement rate in single-time multilevel registration increased to 23.4 % compared to 6.2 % for separate registration. As the distance increased between the registered level and the level of CPS insertion, the preoperative cervical ROM and the rate of CPS misplacement significantly increased. Thus, the rate of misplacement of CPSs is reduced when performing separate registration. Furthermore, when there is greater preoperative cervical ROM, separate registration would likely improve the safety and accuracy of CPS insertion.     

O型臂联合CT三维导航系统辅助颈椎椎弓根螺钉置入的准确性研究

目的:探讨O型臂联合CT三维导航系统辅助颈椎椎弓根螺钉置钉的准确性,并与侧块螺钉置钉进行比较.方法:回顾性分析2017年3月～2021年2月在我院分别使用O型臂联合CT三维导航系统辅助置入椎弓根螺钉与徒手置入侧块螺钉行颈椎后路内固定术的54例患者,其中男44例,女10例,年龄42～79岁(58.3±9.3岁).根据置钉...