X射线透视辅助徒手法与CT三维图像导航下颈椎椎弓根置钉准确率的对比

发布时间：2018-03-11 15:08

  本文选题：颈椎　切入点：X线　出处：《中国组织工程研究》2017年11期 　论文类型：期刊论文

【摘要】：背景:临床上颈椎椎弓根导航方法相对较多,均能提高围术期置钉准确率,但是这些导航系统尚存在许多不完善之处,如图像质量不高、操作复杂繁琐、实时性差或导航存在创伤性等,难以达到预期的置钉效果。目的:对比X射线透视辅助徒手法与CT三维图像导航下颈椎椎弓根置钉的准确率。方法:取南阳医学高等专科学校第一附属医院收治的颈椎椎弓根置钉患者90例,随机分为2组(n=45),徒手组在X射线透视辅助下徒手法置入132枚颈椎椎弓根螺钉,三维导航组在CT三维图像导航下置入128枚颈椎椎弓根螺钉,记录2组置钉时间、出血量;2组术后均行CT平扫,完成三维重建,比较2组颈椎椎弓根螺钉置钉准确率。结果与结论:(1)三维导航组围术期置钉优良率95.3%显著高于徒手组88.6%(P0.05);(2)三维导航组置钉时间显著长于徒手组(P0.05),置钉出血量显著多于徒手组(P0.05),导航匹配时间及辐射量小于徒手组(P0.05);(3)2组术前JOA评分比较差异无显著性意义(P0.05);三维导航组术后3,6个月JOA评分均显著高于徒手组(P0.05);(4)三维导航组并发症发生率7%低于徒手组16%(P0.05);(5)结果提示,与X射线透视辅助徒手法置钉相比,CT三维图像导航能提高颈椎椎弓根置钉准确率,提高手术安全和精确性。但是CT三维图像导航置钉方法操作相对繁琐,耗费时间较长,造成患者术中出血量较大,应根据患者情况选择合适的置钉方法。
[Abstract]:Background: there are many clinical methods of cervical pedicle navigation, which can improve the accuracy of perioperative nail placement. However, these navigation systems still exist many imperfections, such as low image quality and complicated operation. Poor real-time or traumatic navigation, etc. Objective: to compare the accuracy rate of cervical pedicle screw placement with X-ray fluoroscopy assisted bare-hand method and CT three-dimensional image navigation. Methods: the first affiliated Hospital of Nanyang Medical College was selected and admitted to Nanyang Medical College. A total of 90 cases of cervical pedicle screw insertion were reported. Two groups were randomly divided into two groups: the bare-handed group was assisted by X-ray fluoroscopy, 132 cervical pedicle screws were inserted with the aid of X-ray fluoroscopy, and 128 cervical pedicle screws were placed in the three-dimensional navigation group under the guidance of CT three-dimensional image, and the time of fixation in the two groups was recorded. In both groups, CT scan was performed before and after operation, and 3D reconstruction was completed. Results and conclusion the excellent and good rate of screw insertion in the 3 D navigation group was significantly higher than that in the bare hand group (88. 6% P 0. 05) the time of nail placement in the 3 D navigation group was significantly longer than that in the bare hand group (P 0. 05%) and the blood loss was significantly higher in the 3 D navigation group than in the bare hand group (P 0. 05). There was no significant difference in the preoperative JOA score between the two groups (P 0.05), and the JOA score in the 3 D navigation group was significantly higher than that in the 3 D navigation group at 3 and 6 months after operation (P 0. 05%, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). The results indicated that the rate of 7% was lower than that of the bare hand group. Compared with X-ray fluoroscopy assisted manual nail placement, CT 3D image navigation can improve the accuracy of cervical pedicle screw placement, and improve the safety and accuracy of surgery, but the operation of CT 3D image navigation nail placement method is relatively cumbersome and time-consuming. Due to the large amount of blood loss during operation, the proper method of nail placement should be selected according to the patient's condition.
【作者单位】： 南阳医学高等专科学校第一附属医院放射科;南阳医学高等专科学校第一附属医院神经内科;
【基金】：河南省卫生科技攻关项目(2014HNA0122)~~
【分类号】：R687.3;R816.8

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