影像导航引导椎弓根钉加椎间融合治疗腰椎滑脱症

Computer-assisted fluoroscopic navigation to guide the treatment of spondylolisthesis with pedicle screw fixation and intervertebral fusion.

目的探讨影像导航系统引导椎弓根钉加椎间融合治疗腰椎滑脱症的有效性和效果。方法对56例腰椎滑脱患者在脊柱影像导航系统引导下利用椎弓根螺钉滑脱椎体进行复位固定加椎管减压、椎间融合术。手术后对内植物和导航虚拟影像进行测量，疗效采用JOA下腰痛评分标准评定术前、术后分数，同时观察临床疗效及融合率。结果植入物实际影像图与导航虚拟手术路径图重叠，复查CT示内植物位置理想，椎弓钉位置评级：理想210枚（94％），术后随访时间6个月-1年10个月，术前JOA评分平均7分，随访时为12．5分，优良率91％。结论影像导航系统引导椎弓根钉加椎间融合治疗腰椎滑脱症，植入前可以虚拟出内固定植入的手术环境和路径；植入中可以实时追踪手术器械的位置变化，使内植物精确植入最佳位置，提高了椎弓根钉和融合器植入安全性，提高手术疗效。

Objective To explore outcomes and validity of computer-assisted fluoroscopic navigation to guide the treatment of spondylolisthesis with pedicle screw fixation and intervertebral fusion. Methods 56 patients were treated with pedicle screw fixation and reduction with intervertebral fusion by guide of the computer-assisted fluoroscopic navigation. After operation, the internal material and navigation imaging were measured. Operative efficacy and fusion percent were judged by JOA grade system. Results Excellent correlation was observed in X-ray image of the implants and virtual image of fluoroscopy. For pedicle screws,210（94% ） was excellent. After 6 months to 1 year and 10 months following-up,91% of the patients obtained successful chnical outcome . Preoperative average JOA score was 7 and postoperative score was 12.5. Conclusions Computer-assisted fluoroscopic navigation to guide the treatment of spondylohsthesis with pedicle screw f＇Lxation and intervertebral fusion can imitate the virtual image and entering path ,which also can pursue the position of the surgical instrument and then let the internal fixation approach to the precise position , increasing the security of implant.