导航模板辅助寰枢椎椎弓根置钉的临床应用与研究
发布时间：2018-04-27 23:22
本文选题：寰枢椎 + 椎弓根螺钉 ； 参考：《延安大学》2017年硕士论文
【摘要】：目的:探讨导航模板辅助寰枢椎椎弓根置钉的准确性与临床应用的可行性,为临床寰枢椎椎弓根置钉提供参考。方法:收集我院脊柱外科病区自2014年12月至2016年12月期间收治的寰枢椎骨折和或脱位行后路椎弓根固定患者的临床资料,按照纳入与排除标准的要求共24例患者纳入本次研究,根据随机分组的原则将入组患者分为实验组与对照组,其中实验组12例行导航模板辅助置钉,对照组12例行徒手置钉。1.对两组患者常规行术后CT扫描,使用S.Kaneyama法评价两组患者的置钉准确性,并作统计学评价;2.记录两组患者手术时间、术中出血量及透视次数,并作统计学评价;3.记录两组患者术前JOA、VAS评分,同时随访两组患者术后半年JOA、VAS评分,并作统计学评价。结果:1.实验组12例患者共置入寰枢椎椎弓根螺钉48枚,其中0级48枚、Ⅰ级0枚、Ⅱ级0枚、Ⅲ级0枚,置钉满意度(0级与Ⅰ级螺钉被认为是置钉满意螺钉)为100㳠;对照组12例患者共置入寰枢椎椎弓根螺钉螺钉48枚,其中0级34枚、Ⅰ级11枚、Ⅱ级3枚、Ⅲ级0枚,置钉满意度为93.75㳠。两组患者的置钉准确性具有显著性统计学差异(P㩳0.01)。2.实验组与对照组的平均手术时间分别是147.35±32.90min、171.40±34.12min,具有显著性统计学差异(P㩳0.01);平均术中透视次数分别是2.05±0.81次、5.45±1.39次,具有显著性统计学差异(P㩳0.01);平均出血量分别是331.10±83.71ml、372.15±75.46ml,具有显著性统计学差异(P㩳0.01)。3.实验组患者术前、术后半年JOA评分分别为11.91±3.12、15.31±1.12,具有显著性统计学差异(P㩳0.01);对照组术前、术后半年JOA评分分别为12.13±2.32、15.45±0.98,具有显著性统计学差异(P㩳0.01);两组患者术前及术后半年JOA评分均无统计学差异(P㧐0.05)。4.实验组患者术前、术后半年VAS评分分别为5.76±1.42、1.91±0.72,具有显著性统计学差异(P㩳0.01);对照组术前、术后半年VAS评分分别为5.61±1.57、2.05±0.68,具有显著性统计学差异(P㩳0.01);两组患者术前及术后半年VAS评分均无统计学差异(P㧐0.05)。结论:与传统徒手寰枢椎椎弓根置钉相比:1.导航模板可以显著提高置钉的准确性;2.导航模板可以显著减少手术时间、术中透视次数及出血量;3.导航模板在手术前后JOA、VAS评分改善情况方面与徒手置钉相当。导航模板辅助寰枢椎椎弓根置钉具有较大使用价值,临床可行性高。
[Abstract]:Objective: to explore the accuracy and clinical feasibility of using navigation template to assist atlantoaxial pedicle screw insertion, and to provide reference for clinical atlantoaxial pedicle screw insertion. Methods: the clinical data of patients with atlantoaxial fracture and dislocation treated by posterior pedicle fixation from December 2014 to December 2016 were collected. 24 patients were included in the study according to the criteria of inclusion and exclusion. According to the principle of random grouping, the patients were divided into experimental group and control group. The experimental group (12 cases) was treated with navigation template and the control group (12 cases) with unarmed nail. S.Kaneyama method was used to evaluate the accuracy of nail placement in the two groups, and statistical evaluation was made to evaluate the accuracy of the two groups. The time of operation, the amount of blood loss and the times of fluoroscopy were recorded and evaluated statistically. The preoperative JOAA VAS scores were recorded in both groups, and the JOAA VAS scores were evaluated at half a year after operation in both groups. The result is 1: 1. In the experimental group, 48 pedicle screws of atlantoaxial pedicle were implanted in 12 patients. Among them, 48 were in grade 0, 0 in grade 鈪，
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