术中三维CT导航在脊柱矫形中的应用

发布时间：2018-07-03 06:15

  本文选题：术中三维CT导航 + 椎弓根螺钉　； 参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：[目的]通过与徒手置钉技术的比较,探讨在后路全椎弓根螺钉治疗脊柱畸形手术中,术中三维CT导航辅助下置钉技术的准确性优势及临床价值。[方法]回顾分析2009年6月至2012年9期间,于我院脊柱外科行脊柱畸形矫形手术并行术中CT辅助检查的连续100个病例,所有病例非随机分为导航组及非导航组,其中导航组37例,非导航组63例。分组方法：1)根据椎弓根钉置入节段的不同,将两组病例各分为胸椎、上胸椎、中胸椎、下胸椎及腰椎5个亚组；2)根据椎体旋转程度的不同,将每组病例的椎弓根螺钉分为4个亚组(G1=0°, 0G2"f10°,10°G3"f20°,G420°,导航G1组表示以G1。组表示,非导航G1组以G1F组表示,以此类推)。当每个病例所有椎弓根螺钉置入完毕后,行术中CT扫描并三维重建,根据重建图像评定螺钉准确性并予以分级,Ⅱ级和Ⅲ级螺钉评定为误置螺钉并重新置入。比较并分析两组整体间及各亚组间椎弓根螺钉的置钉准确性,以及在不同椎体旋转程度的情况下,导航组和非导航组椎弓根置钉的破出率和误置返修率。[结果]导航组37例患者男性19例,女性18例,年龄3～77岁,平均25.03±18.58岁,非导航组63例患者男性28例,女性35例,年龄3～63岁,平均18.87±12.04岁,两组年龄及性别均无统计学差异(P年龄=0.5291,P性别=0.1307)。导航组总体椎弓根置钉准确率(94.61%)高于非导航组(88.43%)(P0.05),返修率(2.43%)低于非导航组(6.06%)(P0.05)。各亚组间比较,导航胸椎组、中胸椎组、下胸椎组椎弓根置钉准确率均高于非导航对应组(P0.05),返修率均低于非导航对应组(P0.05)；两组上胸椎组间及腰椎组间准确率及返修率差异均无统计学意义(P0.05)。按旋转程度分类比较,G1N组和G2N组的置钉破出率及误置返修率与G1F组和G2F组无统计学差异(P0.05),但G3N组和G4N组的置钉破出率及误置返修率明显低于G3F组和G4F组(P0.05)。[结论]术中三维CT导航技术可提高脊柱矫形手术中的椎弓根螺钉置钉准确性,尤其是胸椎弓根置钉以及椎体旋转角度大于10。时的置钉准确性。
[Abstract]:[objective] to evaluate the accuracy and clinical value of 3 D CT navigation assisted screw placement in posterior total pedicle screw surgery for spinal deformity by comparing with the technique of free hand screw insertion. [methods] from June 2009 to September 2012, 100 consecutive cases of spinal deformities underwent orthopedic surgery and intraoperative CT assisted examination in our hospital were analyzed retrospectively. All the cases were not randomly divided into navigation group and non-navigation group. There were 37 cases in navigation group and 63 cases in non-navigation group. Methods: 1) according to the different pedicle screw placement, the two groups were divided into 5 subgroups: thoracic vertebra, upper thoracic vertebra, middle thoracic vertebra, lower thoracic vertebra and lumbar vertebrae) according to the degree of vertebral rotation, the two groups were divided into 5 subgroups: thoracic vertebra, upper thoracic vertebra, middle thoracic vertebra, lower thoracic vertebra and lumbar vertebrae. The pedicle screws of each group were divided into 4 subgroups (G 1 0 掳, 0 G 2 "f 10 掳10 掳10 掳G 3" f 20 掳G 420 掳, G 1 group was expressed as G 1. The non-navigation G1 group is represented by the G 1 F group, and so on. After all pedicle screws were implanted in each case, CT scan and 3D reconstruction were performed during the operation. The accuracy of the screws was evaluated and graded according to the reconstructed images, and the grade 鈪，

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