脊柱侧弯矫正术中三维导航椎弓根钉置入的意义

Intraoperative three- dimensional navigation used in pedicle screw placement for correction of scoliosis

摘要:

[目的] 探究术中导航系统在脊柱侧弯矫形手术置钉中的临床应用效果。[方法] 回顾性分析本院 2015 年 7 月— 2018 年 7 月手术治疗的脊柱侧弯 40 例患者的临床资料，依据术前医患沟通结果，21 例采用术中三维即时导航系统辅助置钉 （导航组），19 例采用传统徒手方法置钉 （徒手组）。比较两组围手术期、随访及影像资料。[结果] 所有患者均顺利手术，无严重术中并发症。导航组置钉准确度 [A/B/C/D/E, (221/8/5/0/0) vs (174/19/12/7/0), P＜0.001]、手术时间 [(43.7±12.2) min vs (65.4± 19.7) min, P＜0.001]、术中出血量 [(623.2±40.5) ml vs (1 024.3±38.3) ml, P＜0.001]、单钉置入时间 [(2.2±1.3) min vs (5.1±2.4) min, P＜ 0.001] 均显著优于徒手组，但两组间下地行走时间、住院时间差异无统计学意义 （P＞0.05）。40 例患者随访 12~24 个月，平均 （18.2±4.6） 个月，随时间推移，两组患者 VAS 评分及 ODI 均显著下降 （P＜0.05）。相应时间点，两组间 VAS 及 ODI 评分的差异均无统计学意义 （P＞0.05）；两组患者均未出现后期畸形加重，均无翻修手术等并发症。影像方面，与术前相比，术后 2 周及末次随访两组的主弯 Cobb 角、后凸 Cobb 角、C₇PL-CSVL 及 SVA 均显著改善（P＜0.05）；相应时间点，两组间上述影像测量指标比较均无明显差异（P＞0.05）。[结论]术中即时三维导航系统的应用使脊柱侧弯矫正手术置钉更加准确、快速，降低了手术风险，临床效果显著。

Abstract:

[Objective] To explore the clinical efficiency of the intraoperative navigation system used in pedicle screw placement for correction of scoliosis. [Methods] A retrospective study was conducted on 40 patients who underwent surgical correction with pedicle screw-rod system for scoliosis in our hospital from July 2015 to July 2018. According to the preoperative doctor-patient communication, 21 patients had the pedicle screws placed assisted by intraoperative three- dimensional real-time navigation system (the navigation group), while the remaining 19 patients had screws placed by the traditional freehand technique (the freehand group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed smoothly without serious complications. The navigation group proved significantly superior to the freehand group in terms of accuracy of screw placement [A/B/C/D/E, (221/8/5/0/0) vs (174/19/12/7/0), P＜0.001], operation time [(43.7±12.2) min vs (65.4±19.7) min, P＜0.001], in- traoperative blood loss [(623.2±40.5) ml vs (1024.3±38.3) ml, P＜0.001], a single screw insertion time [(2.2±1.3) min vs (5.1±2.4) min, P＜ 0.001], but there was no significant difference in walking time and hospital stay between the two groups (P＞0.05). As time went during fol- low-up period lasted for 12~24 months, with an average of (18.2±4.6) months, both VAS and ODI scores in both groups significantly de- creased (P＜0.05). At any corresponding time points, there were no significant differences in VAS and ODI scores between the two groups (P＞0.05). There was no complications, such as later deformity aggravation and revision surgery in any patients in both groups. Regarding im- aging, the Cobb angle of main curvature, kyphotic Cobb angle, C₇PL-CSVL and SVA significantly improved in both groups 2 weeks after surgery and at the last follow- up compared with those preoperatively (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). [Conclusion] Application of the intraoperative real-time 3D navigation system makes pedi- cle screw placement for correction of scoliosis more accurate and rapid, reduces the risk of surgery, and achieve significantly improved clini- cal efficiency.