计算机导航辅助椎弓根螺钉固定的临床研究

目的椎弓根螺钉固定是脊柱病变切除后稳定性重建的标准方法。常规术中透视监测行颈胸节段椎弓根螺钉固定具有相当挑战性,本文旨在就计算机导航辅助椎弓根螺钉固定技术进行初步分析。方法2005年1月至2006年3月在计算机导航系统辅助下,对21例患者（年龄17～63岁,平均43．4岁）共行102枚椎弓根螺钉固定。术前采用0．75mm薄层螺旋CT数据扫描并导入计算机工作站进行脊柱三维重建;术中进行工具注册和匹配后对椎弓根螺钉固定进行实时显示。术后所有病例均采用CT和X线平片随访监测效果。结果手术顺利,螺钉大小选择合适,102枚椎弓根螺钉中100枚螺钉（98%）固定位置及方向准确,2枚椎弓根螺钉突破椎弓根外壁距离小于2mm。所有操作均未发生血管和神经损伤并发症。术中透视次数及手术室人员所受X线辐射量明显减少。结论计算机导航辅助椎弓根螺钉固定是一项安全的手术,且手术精度高。

Clinical study on computer navigation assisted pedicle screw placement

Objective Pedicle screw fixation in the spine surgery has become the standard of care for various causes of spinal instability.However,screw placement in the cervical and thoracic spine can be extremely challenging with standard fluoroscopic techniques.The goal of this study is to analyze computer navigation technology applied in pedicle screw placement in spinal surgery.Methods From January 2005 to March 2006,21 patients with an average age of 43.4 years old (ranging from 17 to 63 ) underwent spinal surgery.102 screws were inserted with the aid of computer navigation.Spiral CT scan with 0.75mm slice thickness was used to establish the three dimensional model.The image data set was transferred to the image- guided workstation,which performed an automated registration and surface matching.Using the workstation display,pedicle screw trajectories were planned.Real-time screw tip information was three dimensionally identified in each step of screw insertion.Postoperative fluoroscopy and CT scans were obtained in all patients enrolled in the study.Results The overall surgery-related outcome was satisfactory.The sizes of screws were suitable.The position and direction were accurate.One hundred (98.0%) of 102 screws were placed completely within the cortical podicle margins.Despite use of the navigation system,2 screws perforated the pedicle wall by less than 2 ram.Complications such as neural damage or vascular injury were not demonstrated in the study.During operation the number of fluoroscopy and the amount of X-ray radiation decreased significantly.Conclusion Application of computer navigation to assist pedicle screw placement is safe and accurate.