三维导航在脊柱畸形或翻修手术患者椎弓根螺钉置入中的应用

Application of spinal navigation with the intra-operative 3D-imaging modality in pedicle screw fixation for congenital spinal deformity or spinal revision

目的:探讨三维影像脊柱导航指导脊柱畸形或脊柱翻修手术患者椎弓根螺钉置入的准确性。方法:2003年9月～2007年12月,收治脊柱存在先天畸形或脊柱后柱结构缺损需进行椎弓根螺钉系统内固定的患者58例,其中先天性脊柱侧凸并脊髓畸形31例、全椎板或半椎板切除术后脊柱不稳27例,在减压解除神经压迫同时在三维影像脊柱导航引导下行椎弓根螺钉固定矫形,采用三维影像系统评估螺钉位置的准确性,螺钉完全位于椎弓根内为置钉位置准确;记录螺钉平均置入时间、手术时间、出血量和近期并发症。结果:58例患者共置入426枚螺钉,螺钉位置准确率为96%,螺钉平均置入时间3.90±0.87min/枚,手术时间147±65min,出血量312±185ml,未出现螺钉置入相关的并发症。结论:术中应用三维影像导航对脊柱畸形或脊柱翻修手术患者行椎弓根螺钉置入快速、精确和安全,为高风险的脊柱脊髓畸形及脊柱翻修手术的精确性、安全性提供了保证。

Objective：To evaluate the efficacy and safety of spinal navigation with the intra-operative 3D- imaging modality in pedicle screw fixation for congenital spinal deformity or spinal revision.Method：From September 2003 to December 2007,58 patients including congenital deformity of spine and spinal cord（31 cases） and spinal instability after laminectomy or semi-laminectomy（27 cases） were instrumented with pedicle screw system by spinal navigation with the intra-operative 3D-imaging system.The position of pedicle screw was assessed by intra-operative 3D-imaging system.The position of the pedicle screws,mean time of pedicle screw implantation,operating time,blood loss and post-operative complication were recorded.Result：The accurate rate of pedicle screw position was 96% in these cases.The mean time of pedicle screw implantation ,operating time and blood loss were 3.90±0.87 minutes,147±65 minutes and 312±185ml respectively.There was no implant-related complication occurred during the operation.Conclusion：With spinal navigation combined with the intra-operative 3D-imaging modality,implantation of the pedicle screw in patients with congenital spinal deformity or spinal instability after laminectomy or semi-laminectomy becomes more rapid,accurate and safe.h ensures the accuracy and safty of the high risk surgery for the deformity of spine and spinal cord,and spinal revision.