三维导航与传统C型臂X线机辅助经皮椎弓根螺钉内固定治疗胸腰椎骨折对比研究

发布时间：2018-08-24 17:03

【摘要】：目的 :比较应用三维导航与传统C型臂X线机辅助经皮椎弓根螺钉固定治疗胸腰椎骨折手术的置钉准确性与安全性。方法:我院2015年5月~2016年12月接受经皮椎弓根螺钉内固定手术的胸腰椎骨折患者53例,按置钉辅助设备的不同分为两组:传统组29例,螺钉置入在C型臂X线机辅助下完成;导航组24例,螺钉置入在三维导航系统辅助下完成。记录每例患者术前腰背痛视觉模拟评分(visual analogue scale,VAS)、单枚螺钉置入时间、穿刺针调整次数、射线暴露时间、术中出血量、术后2d腰背部痛VAS评分及术后并发症发生情况。根据术后CT来评估两组置钉情况,依据Certzbein-Robbins改良分级来比较螺钉置入的准确性和安全性,将Ⅰ类螺钉所占比例定义为准确率,Ⅰ类和Ⅱ类螺钉所占比例定义为安全率。随访期内观察围患者并发症发生情况及钉棒断裂松脱情况。结果:两组病例年龄、性别、术前腰背痛VAS评分、骨折类型及骨折椎体分布情况无统计学差异。传统组置钉准确率为76.72%(89/116),安全率为95.69%(111/116);导航组置钉准确率为90.63%(87/96),安全率为100%(96/96)。两组患者术后均未发生神经损伤等手术并发症,无断钉断棒及螺钉松脱情况发生。导航组在术中穿刺针调整次数、术后2d腰背部痛VAS评分、置钉准确率及安全率方面较传统组有明显优势(P0.05),在平均螺钉置入时间、术中出血量方面与传统组无统计学差异,在术中射线暴露时间方面明显长于传统组(P0.05)。结论:三维导航技术能显著提高胸腰椎骨折经皮椎弓根螺钉置入的准确性和安全性,但患者会受到更长时间的射线暴露。
[Abstract]:Objective: to compare the accuracy and safety of three-dimensional navigation and conventional C-arm X-ray machine assisted percutaneous pedicle screw fixation for thoracolumbar fractures. Methods: from May 2015 to December 2016, 53 patients with thoracolumbar fractures underwent percutaneous pedicle screw internal fixation in our hospital were divided into two groups according to the difference of screw insertion aids: the traditional group (29 cases), the screws were implanted with C-arm X-ray machine. In the navigation group, 24 cases were performed with screw placement assisted by three-dimensional navigation system. The preoperative visual analogue score (visual analogue scale,VAS) of low back pain, the time of placement of single screw, the adjusting times of puncture needle, the time of radiation exposure, the amount of intraoperative bleeding, the VAS score of lumbar and back pain 2 days after operation and the occurrence of postoperative complications were recorded in each patient. The accuracy and safety of screw placement were compared according to the modified Certzbein-Robbins classification. The ratio of type I screws was defined as accuracy rate, and the proportion of type 鈪，

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