O型臂影像及导航系统在脊柱外科的临床应用

Effect of O-arm imaging and navigation system in spinal surgery

目的探讨O型臂(O-arm)影像及导航系统在脊柱外科的临床应用价值。方法选择2020年6月-2021年3月于天津医科大学总医院脊柱外科行椎弓根穿刺的病例共586人,其中应用O型臂(O-arm)影像及导航系统的278人,共计引导穿刺路径1153个,X光引导下徒手穿刺308人,共计穿刺路径1356个。穿刺后均采用O型臂(O-arm)影像系统进行术中二维+三维扫描,根据Rampersaud分类方法评估穿刺路径的准确性。结果两组的年龄、性别、体质量指数、术中出血量均无统计学意义(P>0.05)。导航穿刺组手术时间(122.6±50.4 min)大于徒手穿刺组(108.3±42.7 min)(P<0.05)。穿刺精确性比较:导航穿刺组A级有1116例(占96.8%),B级有14例(占3.2%),无C级和D级病例;徒手穿刺组A级有1244例(占91.7%),B级有103例(占7.6%),C级有9例(占0.7%),无D级病例,导航穿刺组穿刺的准确率优于徒手穿刺组,两组比较,差异均有统计学意义。结论O型臂导航可以有效提高脊柱穿刺操作的准确性和安全性,但手术时间相对更长。

Objective To investigate the clinical application value of O-arm imaging and navigation system in spinal surgery.Methods From June 2020 to March 2021,the clinical data of 586 patients underwent pedicle puncture in the Department of Spinal Surgery,General Hospital of Tianjin Medical University were retrospectively analyzed.Among them,the puncture in 278 patients were guided by O-arm imaging and navigation system,with a total of 1153 puncture paths and that in the rest 308 patients by X-ray,with a total of 1356 puncture paths.After puncturing,the O-arm imaging system was used for intraoperative two-dimensional and three-dimensional scanning,and the accuracy of puncture path was evaluated according to the Rampersaud classification method.Results There were no significant differences in age,gender,body mass index and intraoperative blood loss between the two groups(P>0.05).The operation time of navigation puncture group was(122.66±50.4 min),significantly higher than that in the X-ray-guided group(108.3±42.7 min)(P<0.05).In the navigation group,the puncture reached grade A in 1116 paths(96.8%),grade B in 14 paths(3.2%),and there were no grade C and D in the cases.In the X-ray-guided group,the puncture reached grade A in 1244 paths(91.7%),grade B in 103 paths B(7.6%)and grade C in 9 paths(0.7%)and there were no grade D in the cases.The accuracy rate of the navigation puncture group was significantly higher than that of the X-ray-guided group.Conclusion O-arm imaging and navigation can effectively improve the accuracy and safety of spinal puncture operation,but the operation time is relatively longer.