经皮穿刺套管导向器的设计和临床应用

目的设计一种经皮穿刺套管导向器,以期提高齿状突螺钉及侧块关节螺钉置入的成功率及置入质量。方法对13具尸体模拟经皮前路C1~2侧块关节螺钉手术内固定,进而应用于临床治疗患者7例。术中均使用经皮穿刺套管导向器,记录手术用时、放射线剂量及影像学评价螺钉位置优良率。回顾性分析上颈椎经皮前路内固定手术32病例,统计上述三项指标。结果13具尸体模拟手术,螺钉植入26枚,手术用时为(50.25±9.07)min,螺钉固定优良率92.31%,放射线量仅为(0.395±0.105)Gycm2。临床患者7例螺钉植入14枚,手术用时35~72min,平均(52.71±9.54)min;固定螺钉位置优良率100%,放射线量仅为(0.411±0.081)Gycm2。未用套管导向器的32例临床病例组,手术用时为(116.72±13.22)min,固定螺钉位置优良率70.31%,放射线量仅为(0.690±0.124)Gycm2。统计使用导向器与未用导向器两组结果具有显著性差异。结论使用经皮穿刺套管导向器可提高侧块螺钉置入的准确性、减少X线对手术人员的辐射量及缩短手术时间。

The design of percutaneous puncture cannula guide device and its clinical application

Objective To design a device for guiding the angle of the percutaneous puncture cannula in order to increase the quality of screw placement and decrease the accident of screws violation during transarticular lateral masses screw and odontoid screw placement.Methods Thirteen cadavers were placed percutaneous transarticular atlantoaxial screws under the guide device in the simulative operation. Ideal deviated angel before operation and actual deviated angel after operation of screw were measured by computer tomography. Operative time, quantity of radioactive ray and evaluation of screw angle were respectively recorded. The device was also used in 7 clinical cases. Thirty-two clinical cases with upper cervical anterior percutaneous fixation were retrospectively analyzed on the same items.Results In the simulative operation, 26 screws were placed, 92.31% trajectories of the screws were good, average operative time was 50.25±9.07 minutes, and the average quantity of radioactive ray was 0.395±0.105 Gycm². In 7 clinical cases, 14 screws were placed, 100% screws' trajectories were good, the average operative time was 52.71±9.54 minutes, and the average quantity of radioactive ray was 0.411±0.081 Gycm². Whereas, in 32 clinical cases without using percutaneous puncture cannula guide device, 64 screws were placed, 70.31% screws' trajectories were good, the average operative time was 116.72±13.22 minutes, and the average quantity of radioactive ray was 0.690±0.124 Gycm². There was significant difference between two groups.Conclusion Screw placement under the guide of the percutaneous puncture cannula device can significantly enhance the success rate, reduce the accident of screw violation, shorten the operative time and decrease the quantity of radioactive ray.