摘要
目的：探讨三维CT导航系统在胸腰椎椎弓根螺钉内固定中的应用价值。方法：三维CT导航系统辅助下，对导航组13例患者植入胸腰椎椎弓根螺钉65枚，其中胸椎骨折4例、腰椎骨折7例、腰椎滑脱症2例；在x线透视下对传统组14例患者植入胸腰椎椎弓根螺钉70枚，其中胸椎骨折3例、腰椎骨折7例、腰椎滑脱症2例、崾椎间箍突出症2例。术后均行CT扫描，按Richter分类法评估螺钉的位置。结果：术后按Richter分类法评估，导航组螺钉位置优62枚（95．4％），良3枚（4．6％），差0枚；传统手术组优57枚（81．4％），良10枚（14．3％），差3枚（4．3％）。两组置钉准确性差异有统计学意义（P〈0．05）。两组术后均无神经、脊髓损伤。24例随访0．5～1．0a，复查X线片和CT，无螺钉松动和断裂钉，无迟发性脊髓损伤。结论：三维CT导航系统可以准确引导胸腰椎椎弓根螺钉的植入，手术精度高，并发症少。
Objective：To assess the value of 3D - CT navigation system in guiding pediele screw fixa- tion of thoracolumbar spine. Methods：With the help 3D - CT navigation system, 65 pedicle screws were im- planted into 13 patients, which consisted of 4 cases with thoracic vertebral fi＇aeture, 7 fractures of lumbar verte- bra and 2 lumbar spondylolisthesis. In contrast, By an X - ray transilluminator guiding, 70 pediele screws placement were performed on 14 patients including 3 cases of thoracic vertebral fracture, 7 fractures of lumbar vertebra, 2 lumbar spondylolisthesis and 2 lubar intervertebral disc protrusion. The positions of all pedicle screws were scanned by CT and evaluated according to the Richter grading system after the operations. Results： In 3D - CT guidance group, 95.4 % of the screw positions was excellent, 4.6 % good and without mistaken. In traditional X - ray assisted group, 81.4% of the screw positions was excellent, 14.3 % good and 4.3 % bad. There was significant difference between two groups in accuracy of placing screw （P 〈 0.05）. No postop- erative nerve and spinal injuries were observed in two groups. Twenty - four cases were followed up for a period of 6 - 12 months, no loose or breakage of screws and tardive delayed spinal cord injuries were observed by reex- amination of X -ray and CT. Conclusions：3D - CT navigation system can accurately guide the thoracolumbar pedicle screw implants, improve the surgical precision, and reduce complications.
出处
《解剖与临床》
2009年第1期28-30,33,共4页
Anatomy and Clinics
基金
基金项目：2006年安徽省卫生厅临床医学应用技术项目（068044）
