计算机辅助导航在脊柱脊髓手术中的应用

目的 对计算机辅助导航系统在椎管内肿瘤及内固定手术应用中的精确性、安全性、易行性等进行了分析。方法2001年3月至2003年12月期间共在计算机辅助导航系统下实施了41例脊柱导航手术：椎管内外占位性病变37例,内固定手术4例。其中男29例,女12例,年龄14～69岁,平均43岁。病变位于颈段9例,胸段17例,腰段13例,骶尾段2例。结果本组37例椎管内外占位患者中19例病变位于髓内,18例位于髓外,其中4例侵及椎管内外。其中神经鞘瘤9例,室管膜瘤10例,血管网织细胞瘤5例,脊膜瘤7例,星形细胞瘤4例,囊虫1例,骨母细胞瘤1例。占位性病变中手术镜下全切33例(89．2％),2例近全切除,2例大部切除。内固定手术4例,共植入26枚螺钉,未发生螺钉穿破皮质及损伤脊髓和神经根。术后患者恢复良好34例(82．9％),无术后感染及死亡病例。结论计算机辅助导航系统作为一种手术辅助方法为医生实施脊柱脊髓手术提供了重要的帮助,它在精确性、安全性、易行性等方面达到了微创手术的要求,并且在术前计划、减少手术损伤、降低手术并发症及手术教学等方面有着巨大的潜力。

Application of computer-assistant neuronavigation in spinal operation

OBJECTIVE: To discuss the efficacy, accuracy, and safety of computer-assistant neuronavigation in operation of vertebrae and spinal cord. METHODS: The data of computer-assistant neuronavigation used in the operation for 41 cases, including 9 cases of neurinoma, 10 cases of ependymoma, 5 cases of angioreticuloma, 7 cases of spinal meningioma, 4 cases of astrocytoma, and 1 case of cysticercosis, and 1 case of osteoblastoma. from March 2001 to December 2003 were reviewed. RESULTS: Twenty-six screws were fixed in 4 patients. Total removal was succeeded in 33 of the 37 cases of 37 spinal tumors and all patients survived after operation. CONCLUSION: Image-guided navigation for spinal surgery is able to save time and reduce operational lesion. More importantly, it improves neurosurgeon's comprehension of spinal anatomy.