改良二维导航模拟椎体三维影像引导椎弓根钉内固定在腰椎疾患中的应用

目的 探讨改良二维导航模拟椎体三维影像的方式引导椎弓根钉内固定在腰椎疾患中的应用.方法 对43例行腰椎椎弓根钉内固定手术患者,获取手术椎体正、侧位及左、右斜位X线片,采用改良二维导航的方法模拟成椎体的正、侧位及椎弓根轴位片,引导椎弓根钉的置入.结果 术中共置人188枚椎弓根钉,导航模拟路径与实际椎弓根钉影像位置平均偏差1.5 mm,角度平均偏差0.8°.术后CT显示全部椎弓根钉均位于椎弓根内,未出现涉及或突破椎弓根皮质的现象.术后CT测量椎弓根钉与椎体纵轴角度和术前预测的矢状位角度平均偏差1.0°.结论 改良二维导航方法简单方便,通过获取手术椎体正、侧位及左、右斜位X线片,可模拟椎体的正、侧位及椎弓根轴位的三维影像,从而可以更加精确地引导椎弓根钉的置入.

Improved 2D computer-assisted fluoroscopic navigation of imitation 3D vertebra image to guide pedicle screw in lumbar disease

Objective To explore clinical outcomes of using improved 2D computer-assisted fluoroscopic navigation of inu'tation 3D vertebra image to guide the pedicle screws in lumbar disease. Methods The anterio posterior, lateral and oblique radiographic materials were got in 43 lumbar disease patients performed neck of vertebra internal fixation, and used the method of improved computer-assisted fluoroscopic navigation to imitate anterio posterior, lateral spinal and axial pedicle virtual image to guide the pedicle screws implantation. Results One hundred and eighty-eight lumbar pedicle screws were implanted, deviation mean position 1.5 mm and mean angle deviation 0.8° in match navigation virtual path with real pedicle screws image. Postoperative CT showed all pedicle screws contained within the pedich, without invasion to lateral and inner bone cortical of the pediele. Deviation mean 1.0° by measured pedicle screws with longitudinal axis vertebra compared with preoperational predict implant screws sagttial angle. Conclusions Improved 2D computer-assisted fluoroscopic navigation is simple and convenient, use anterio posterior,lateral and oblique radiographic materials to imitate anterio posterior,lateral spinal and axial pediele virtual image can precisely guide the pedicle screws implantation.