计算机导航技术在脊柱椎弓根钉固定中的应用

Clinical applications of computer-assisted navigation technique in spinal pediicle screw internal fixation

目的探讨术前CT扫描三维虚拟图像导航技术在脊柱椎弓根螺钉固定术中的应用价值。方法95例行脊柱椎弓根螺钉固定术的患者，随机分为两组，一组在计算机导航技术辅助下植入椎弓根螺钉（导航组），一组采用传统的解剖标志法结合术中透视定位植入椎弓根螺钉（常规组）。比较两组间的螺钉钉道准备时间、螺钉位置的优良率和术后并发症的发生率。结果导航组36例患者共植入椎弓根螺钉206枚，其中优169枚（82．0％）、良29枚（14．1％）、差8枚（3．9％），优良率96．1％。有9例患者因故未能行导航。常规组50例患者共植入椎弓根螺钉285枚，其中优257枚（90．2％）、良28枚（9．8％），无位置差的螺钉，优良率100．0％。两组螺钉优良率间差异无统计学意义（P〉0．05）。螺钉钉道准备时间导航组为（9360±22）S，常规组为（56±8）s，两组差异有统计学意义（P〈0．001）。两组患者术后均无并发症发生。结论术前CT扫描三维虚拟图像导航技术与传统解剖标志定位法植入椎弓根螺钉的精度无明显差异；且延长了手术时问，其在脊柱椎弓根螺钉固定中的应用价值有限。

Objective To assess the value of computer navigation technique in spinal pedicle screw insertion. Methods 95 patients undergoing spinal pediicle screw internal fixation were randomly divided in 2 groups ： navigation group （ n = 36 ） undergoing pediele screw insertion with computer-assisted navigation technique, and conventional group （ n = 50） undergoing pedicte screw insertion using conventional anatomic landmark combined. The 2 groups were compared in respect to screw canal preparation time, accuracy of screw position, and incidence of postoperative complication. Results 206 screws were inserted in the navigation group,169 being with excellent outcome （82. 0% ） ,29 with good outcome （ 14. 1% ） ,and 8 with bad outcome （3.9%）. Nine patients in the navigation group failed to adopt the computer-assisted navigation technique because of different reasons. 285 screws were inserted in the conventional group, 257 being were excellent butcome （ 90. 2% ） , 28 with good outcome （ 9. 8% ） , and none with bad outcome. The general fitness rate of the navigation group was 96. 1%, not significantly different from that of the conventional group （ 100% ,P 〉 0. 05 ） . The screw canal preparation time of the navigation group was （ 360 ± 22 ） see, significantly longer than that of the conventional group [ （ 56 ± 8 ） see, P 〈 0. 001 ） ] . No postoperative complication was found in both groups. Conclusion The accuracy of pediele screw insertion using preoperative CT-based navigation technique is not different from that using conventional anatomic landmark, but the operation time is significantly prolonged. Preoperative CT-based navigation technique has limited value in spinal pedicle screw insertion.