计算机导航系统和C臂机透视引导颈椎椎弓根螺钉内固定技术的临床对比研究

Clinical contrast of cervical pedicle screw fixation assisted by C-arm fluoroscopy or 3D navigation system

目的探讨颈椎(C_2～C_7)椎弓根螺钉内固定的可行性和两种不同置钉方法的精确性。方法通过术后进行 X 线摄片、CT 或术后 Iso-C 断层扫描等方法,判断 C 臂机透视引导下置入的145枚和三维导航系统(CT 三维导航或 Iso-C 术中三维导航)辅助下187枚颈椎椎弓根螺钉病例的置钉准确性。结果三维导航系统引导组螺钉置入满意率(97.9%,183/187)明显高于 C 臂机透视引导组(91.7%,133/145)(x^2=6.705,P=0.010)。且三维导航系统引导组位置不满意的4枚螺钉均发生于早期病例,导航系统使用熟练后未再出现置钉不满意的病例。两组病例均未出现明显的神经血管损伤并发症(C 臂机透视引导组2例术后一过性上肢疼痛)。对三维导航系统引导组中25例进行术中导航操作时间和导航精确性的监测。CT 三维导航术中工具注册和参考点照合时间平均3.5min(2～8 min),位置误差率平均0.31 mm(0.12～0.56 mm,导航仪自动计算);Iso-C 术中三维导航图像采集和传输时间平均6.2 min(5～7min),每颗椎弓根螺钉定位针置入所需时间平均2min (1～3.5min);术中只需进行2次 C 臂机透视印证螺钉定位针和螺钉置入的准确性。结论采用三维导航系统辅助,能显著提高椎弓根螺钉置入的精确性,其操作技术有待完善。

Objective To evaluate the feasibility and accuracy of cervical （C2-C7 ） pedicle screw fixation assisted by C-arm fluoroscopy or 3D navigation system （CT-based navigation system or Iso-C 3D navigation system）. Methods One hundred and forty-five cervical pedicle screws inserted with C-arm fluoroscopy and 187 pedicle screws inserted with 3D navigation system were observed by postoperative CT or Iso-C 3D scan. The process of navigation was investigated. Results In the 145 screws inserted with C-arm fluoroscopy, 133 screws are accurate （91.7%）,and in the 187 screws inserted by 3D navigation system, 183 screws are accurate （97. 9% ）（χ2 = 6. 705,P =0. 010）, and the 4 misplaced screws occurred in the early stage of navigation system application. The process of navigation was investigated in twenty-five patients. With CT-based navigation, the mean time for registration and surface matching was 3.5 minutes ; with Iso-C 3D navigation, the mean time for images collection and transfer was 6.2 minutes. The mean time for screw-marker insertion was 2 minutes. Conclusions 3D navigation system can increase accuracy of cervical pedicle screw fixation obviously.