颈椎椎弓根螺钉定位系统的实验研究

EXPERIMENTAL STUDY OF CERVICAL PEDICLE SCREW LOCATOR SYSTEM

目的寻找一种新的颈椎椎弓根螺钉植入方法,提高手术安全性并减少手术费用。方法以不锈钢材料制造颈椎椎弓根螺钉定位系统。取自愿捐赠的尸体颈椎标本10个,按照配伍组设计,左、右侧分别为对照组和实验组。对照组采用Abumi徒手植钉法,实验组采用定位系统引导植钉法,于C2～7各植入螺钉60枚。观察螺钉植入情况,以螺钉是否穿出椎弓根壁为标准衡量植钉准确性。结果对照组行椎弓根内植钉32枚(53.33%),椎弓根外植钉28枚(46.67%);造成神经根损伤9枚(15.00%),椎动脉损伤5枚(8.33%),无脊髓损伤;植钉准确率:优32枚,可14枚,差14枚,合格率76.67%。实验组行椎弓根内植钉54枚(90.00%),椎弓根外植钉6枚(10.00%);造成椎动脉损伤1枚(1.67%),无神经根和脊髓损伤;植钉准确率:优54枚,可5枚,差1枚,合格率98.33%,与对照组比较差异有统计学意义(P<0.05)。结论颈椎椎弓根螺钉定位系统引导下植钉准确、操作简便、费用较低,通过进一步研究可应用于临床。

Objective To develop a high-accuracy, better-safety and low-cost cervical pedicle locator system for guiding cervical pedicle screw placement. Methods Cervical pedicle screw locator system was made of stainless steel. Ten cervical specimens from voluntary donation were divided into two groups according to compatibil ity design： control group in which 60 screws were planted into C2-7 by free hand; and experimental group in which 60 screws were planted into C2-7 under the guidance of three-dimensional locator system. The condition of screw insertion was observed and the accuracy was evaluated by the integrity of pedicle walls. Results In the control group, 32 screws （53.33%） were placed inside the pedicles and 28 （46.67%） were outside; 9 screws （15.00%） led to nerve root injury, 5 screws （8.33%） caused vertebral artery injury and no spinal cord injury occurred; and the qual ification ratio of screw insertion was 76.67% （excellent 32, fair 14, poor 14）. While in the experimental group, 54 screws （90.00%） were placed inside the pedicles and 6 （10.00%） were outside; 1 screw （1.67%） caused vertebral artery injury and no nerve root injury and spinal cord injury occurred; and the qual ification ratio of screw insertion was 98.33% （excellent 54, fair 5, poor 1）. There was significant difference between the two groups （P 〈 0.05）. Conclusion Cervical pedicle screw locator system has the advantages of easy manipulation, high accuracy of screw placement and low cost. With further study, it can be applied to the clinical.