骨科数字三维重建技术辅助胸腰椎椎弓根螺钉置钉的准确性

发布时间：2018-03-24 20:54

本文选题：成像　切入点：三维　出处：《中国组织工程研究》2017年03期

【摘要】：背景:随着近年来更精密的影像学仪器的出现,骨科术前检查变得更清晰、准确,借助三维重建技术势必能提高椎弓根钉置入的准确性。目的:探讨数字化三维重建技术辅助胸腰椎椎弓根钉置入的准确性和安全性。方法:收集因脊柱疾病行椎弓根内固定的患者200例,随机分为2组,一组采用传统解剖标志法结合术中透视定位置入椎弓根螺钉(徒手置钉组),一组利用数字化三维重建技术辅助置入胸椎椎弓根钉(辅助置钉组)。通过对比虚拟置钉前后的脊柱数字化模型,记录完成钉道准备时间、手术出血量、置钉准确率、椎弓根神经血管损伤情况。结果与结论:(1)徒手置钉组、辅助置钉组椎弓根螺钉置入准确率分别为85%和99%,两组一次性置入成功率分别为80%和95%,置钉优良率分别为86%和96%,差异无显著性意义(均P0.05);(2)徒手置钉组完成钉道准备时间为(5.87±1.34)min,置钉出血量为(10.08±7.58)m L;辅助置钉组完成钉道准备时间为(3.91±2.28)min,置钉出血量为(18.31±8.56)m L,两项指标组间比较差异有显著性意义(P0.05);(3)徒手置钉组神经损伤6例,血管损伤8例;辅助置钉组神经损伤0例,血管损伤1例,两组神经、血管损伤情况比较差异有显著性意义(P0.05);(4)结果表明,数字化三维重建技术辅助胸腰椎椎弓根钉置入的准确性高、置钉安全。
[Abstract]:Background: with the emergence of more sophisticated instruments of imaging in recent years, the Department of orthopedics preoperative examination become more clear, accurate, with 3D reconstruction technology is bound to improve the accuracy of pedicle screw placement. Objective: To investigate the three-dimensional reconstruction of digital technology assisted thoracic and lumbar pedicle screw placement accuracy and safety. Methods: collected by pedicle spinal diseases internal fixation in 200 cases of patients, randomly divided into 2 groups, one group was treated with the traditional anatomical landmarks method combined with fluoroscopy pedicle screws (unarmed nailing group), a group of using three-dimensional reconstruction technology assisted thoracic pedicle screw placement (auxiliary screw group). By comparing the virtual digital model before and after spinal nail record, complete nail tract preparation time, bleeding volume, pedicle screw accuracy, pedicle nerve and blood vessel injury situation. Results and conclusion: (1) unarmed nailing group, pedicle screw placement assisted group. Screw placement accuracy rate were 85% and 99%, the success rate of the two groups were 80% and 95% one-time placement, placement excellent rates were 86% and 96%, there was no significant difference (P0.05); (2) unarmed nailing group completed the preparation time for screw (5.87 + 1.34) min, screw the amount of bleeding was (10.08 + 7.58) m L; auxiliary screw screw group completed the preparation time for (3.91 + 2.28) min, nailing bleeding (18.31 + 8.56) m L, there were significant differences between groups of two indicators (P0.05); (3) free hand pedicle nail in 6 cases group of nerve injury, 8 cases of vascular injury; 0 cases of screw placement assisted group nerve injury, 1 cases of vascular injury, two nerves, there were significant differences of vascular injury (P0.05); (4) the results show that the three-dimensional reconstruction of digital technology assisted thoracic and lumbar pedicle screw placement accuracy of pedicle screws.

【作者单位】：中山市小榄镇人民医院脊柱创伤骨科;
【基金】：2016年中山市卫生和计划生育局医学科研项目(2016J145)~~
【分类号】：R687.3

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