计算机虚拟X线影像导航定向技术在腰椎椎节稳定手术中的应用

Using computer-assisted fluoroscopic navigation to guide pedicle screws and cages in lumbar segmental instability surgery

目的 探讨导航技术在引导腰椎内植物手术中的应用。方法 对 40例下腰椎节失稳手术 ,采用导航下的椎弓钉加后路椎间钛笼植入技术。内植完成后即作X线正侧位摄片与导航路径进行吻合测量。结果 内植物位置理想 ,进钉点均差 2 .2mm (最大 3mm) ,角度均差 3°(最大 5°) ;Cage深度均差 1.8mm(最大 3 .2mm) ,轴线角度均差 2°(最大 4°)。结论 导航的瞬时追踪功能 ,使术者的手术工具做到实时监测 ,内植物达到精确制导 ,使操作形象、多维化 ,实时感强 。

Objective To introduce a new way to guide the implants in lumbar-stability surgery. Methods For 40 cases with lumbar segmental instability, using computer-assisted fluoroscopic navigation technology as guidance to implant 180 pedicle screws and 64 cages in 50 segments and inter-body spaces. Postimplantatively, to measure the implants' images-error between virtual and live fluoroscopy. Results Excellent correlation was observed. For screws, mean entry-point error was 2.2 mm(max 3 mm), mean trajectory angle difference was 3°(max 5°); For cages, mean depth error was 1.8 mm(max 3.2 mm), mean axis angle difference was 2°(max 4°). Conclusion Fluoroscopic navigation technique enable a single C-arm to provide real-time, multiplanar procedural guidance. It also reduces radiation exposure to the patient and surgical team. It will be an ideal guided method for spinal surgery.