辅助经皮胸腰椎弓根螺钉置入激光定位仪在腰椎压缩性骨折手术中的应用

目的探讨辅助经皮胸腰椎弓根螺钉置入激光定位仪(简称激光定位仪)在经皮椎弓根内固定术治疗单节段腰椎压缩性骨折中的可行性和临床应用。方法前瞻性地纳入32例拟行经皮椎弓根螺钉内固定的单椎体腰椎压缩性骨折病人,随机分为两组,每组16例。观察组采用激光定位仪引导置钉,对照组采用正侧位透视置钉。记录并比较两组的置钉时间、辐射量、手术前后疼痛视觉模拟量表(visual analogue scale,VAS)评分差值;术后通过腰椎CT扫描评价置钉准确度。结果随访时间为3~10个月。观察组和对照组的置钉时间分别为(13.33±2.22)min、(17.81±5.01)min,辐射量分别为(295.28±48.61)μGy、(396.34±89.77)μGy,观察组均显著低于对照组,差异均有统计学意义(P均<0.05);但两组手术前后的VAS评分差值比较,差异无统计学意义(P>0.05)。置钉准确度方面,观察组42钉Ⅰ级、22钉Ⅱ级;对照组23钉Ⅰ级、39钉Ⅱ级、2钉Ⅲ级,观察组的置钉准确度更高,两组数据比较,差异有统计学意义(Z=3.442,P=0.001)。结论辅助经皮胸腰椎弓根螺钉置入激光定位仪引导下经皮椎弓内固定术治疗腰椎压缩性骨折,方法可行,效果满意,可缩短置钉时间,减少术中辐射量,提高置钉准确度。

Clinical application of assisted percutaneous pedicle screw placement laser locator in the operation of lumbar compression fractures

Objective To investigate the feasibility and clinical application of percutaneous pedicle screw placement laser locator in the treatment of single lumbar vertebral compression fractures.Methods Thirty-two patients with single vertebral compression fractures were prospectively enrolled and randomly divided into two groups,16 cases in each group.Experimental group was guided with laser localizer nail placement,and control group was treated with anterolateral fluoroscopy nail placement.The average time of nail placement,average radiation dose and visual analogue scale(VAS)difference before and after operation were recorded.The accuracy of screw placement was evaluated by postoperative lumbar CT scan.Results The follow-up time was 3-10 months.The time of nail placement in the observation group and the control group was(13.33±2.22)min and(17.81±5.01)min respectively,and the radiation dose was(295.28±48.61)μGy and(396.34±89.77)μGy respectively(both P<0.05).There was no significant difference in VAS score between the two groups before and after surgery(P>0.05).In terms of accuracy of screw placement,there were 42 screws of grade I and 22 screws of gradeⅡin the observation group;23 screws of grade I,39 screws of grade II and 2 screws of gradeⅢin the control group.The accuracy of screw placement in the observation group was higher than that in the control group(Z=3.442,P=0.001).Conclusion Percutaneous pedicle screw laser guided percutaneous internal fixation for lumbar vertebral compression fractures is feasible and satisfactory.It can shorten the time of setting screws,reduce intraoperative radiation dose and improve the accuracy of nail placement.