术中三维导航引导的腰椎弓根螺钉植入效果分析

目的 探讨术中三维影像脊柱导航引导下植人腰椎弓根螺钉的效果.方法 2003年9月至2006年12月收治各类腰椎需行椎弓根螺钉内固定患者401例,分别采用术中三维影像脊柱导航(A组)和传统X线透视法(B组)行椎弓根螺钉内固定,同时采用术中三维影像系统评估螺钉位置的精确性;分析比较两组螺钉位置、平均每枚螺钉植入时间、手术时间、出血量和近期并发症.结果 A组(95.3%)螺钉位置优良率明显高于B组(84.1%),平均螺钉植入时间、手术时间、出血量低于B组;A、B两组分别为(3.7±0.6)min和(7.8±2.3)min、(134±48)min和(179±62)min、(272±153)ml和(455±289)ml.A组未发现螺钉植入相关的并发症.结论 术中三维影像脊柱导航使腰椎弓根螺钉植入更精确、快速和安全,减少螺钉相关并发症的发生,降低患者和医生X线被动辐射.为腰椎脊柱手术精确化、微创化、安全化发展提供了一种可靠的选择.

Spinal navigation with intra-operative 3D-imaging modality in lumbar pedicle screw fixation

Objective To evaluate the efficacy and Bafety of spinal navigation with intra-operative 3D-imasing madality in lumbar pedicle screw fixation.Methods 401 patients with lumbar degenerativedisorders or fracture were randomly divided into 2 groups:Group A,undergoing pedicle screw fixation by spinal navigation with inca-operative 3D-imaging system,and Group B undergoing pedicle screw fixation by traditional method.The position of pedicle screw was assessed by intr-operative 3D-imaging system.Theexcellent rate of pedicle screw position,mean time of pedicle Screw implantation,operating time,blood loss,and post-operative complication were compared.Results The excellent rate of pedicle screw position was higher Group A wag 95.3%,significantly higher than that of Group B(84.1%,P＜0.001).The mean time of pedicle screw implantation and operating time of Group A were(3.70±0.65)min,significantly shorter than that of Group B[(7.83±2.32)min,P＜0.1301].The blood loss amount ofGroup A was(272±153) ml,significantly less than that of Group B[(455±289)ml,P＜0.05].However,the total operating time of Group A Was(134±48)min,not significantly different from that of Group B[(179 ±62)min,P＞0.05].Conclusion With spinal navigation combined with the intra-operative 3D-imaging modality,implantation of lumbar pedicle screw is more simplified,more accurate,safer,and with shorter operating time.