术中即时三维导航系统在脊柱畸形矫形手术中的应用

目的:评价术中即时三维导航系统在脊柱畸形矫形手术中的应用价值。方法:选取我院2016年7月至2019年6月收治的脊柱畸形患者40例,其中利用术中即时三维导航系统辅助置入椎弓根螺钉21例,传统徒手置钉19例。结果:两组患者性别、年龄、主弯Cobb角等一般资料比较有可比性(P>0.05)。导航组术中出血量少于传统徒手置钉组(P<0.05),导航组置钉时间显著低于徒手组(P<0.05)。采用Hitesh Modi椎弓根穿破分级标准评价置钉情况,导航组21例共置入螺钉292枚,0级278根(95.21%),1级11根(3.77%),2级2根(0.68%),3级1根(0.34%),4级0根;徒手组19例共置入螺钉314枚,0级269根(85.67%),1级21根(6.69%),2级19根(6.05%),3级3根(0.96%),4级2根(0.64%)。两组螺钉位置优良率差异有统计学意义(P<0.01),术后患者无神经损伤或神经损伤加重表现,均未再次调钉。术前术后两组患者主弯均较术前显著改善(P<0.01),组间比较差异无统计学意义(P>0.05)。结论:术中即时三维导航系统在脊柱畸形矫形手术中置钉更安全、有效、精准。

Application Value of Intraoperative Real-time 3D Navigation System in Spinal Deformity Orthopedics

Objective:To evaluate the application value of intraoperative real-time 3 D navigation system in spinal deformity orthopedics.Methods:40 patients with spinal deformity were treated in our hospital from July 2016 to June 2019.Among them,pedicle screw in 21 cases were placed with instant three-dimensional navigation system during surgery,and 19 with traditional freehand way.Results:There were no statistically significant differences in two groups in general datas such as gender,age,and Cobb angle of the main curve(P>0.05).The intraoperative blood loss in the navigation group was less than that in the traditional freehand group(P<0.05),and the placement duration in the navigation group was significantly lower(P<0.05).Hitesh Modi pedicle puncture classification criteria was used to evaluate the placement of screws,21 patients in the navigation group were implanted with 292 screws,278 in grade 0(95.21%),11 in grade 1(3.77%),and 2 in grade 2(0.68%),level 3 with 1 root(0.34%),level 4 with 0 roots.A total of 314 screws were placed in 19 patients in the freehand group,269 in level 0(85.67%),21 in level 1(6.69%),19 in level 2(6.05%),3 in level 3(0.96%),and 2 in level 4 root(0.64%).There was a statistically significant difference in the excellent and good screw position between the two groups(P<0.01).There was no nerve injury or worsening of the nerve injury in the postoperative patients,the screw was not adjusted again.The main curve of the patients before and after the operation were significantly improved in both groups than before(P<0.01),and there was no significant difference between the groups(P>0.05).Conclusion:Intraoperative real-time 3 D navigation system is safer,more effective and accurate for placing screws during spinal deformity orthopedic surgery.