C臂导航在胸腰椎椎弓根内固定术中应用

Thoracolumbar pedicle screw fixation with C-arm navigation

目的探讨计算机导航技术在胸腰椎椎弓根内固定术中的应用价值。方法在计算机导航下对15例胸腰椎疾患行胸腰椎椎弓根内固定术,术中共用72枚椎弓根螺钉固定。术后进行X线透视及CT平扫,用Richter分类法对螺钉固定位置进行评估。结果所有病例全部在导航下完成,15例均获随访,时间6～24个月,无椎弓根螺钉松动及断裂。螺钉位置根据X线及CT复查结果,按Richter分类法进行评估:优68枚(94.4%),良4枚(5.6%)。术中透视未发现螺钉突入椎管及穿出椎体外,未发生神经根、脊髓、血管损伤。术中C臂X线机透视的次数明显减少,手术时间缩短,手术成功率明显提高。结论C臂导航能够明显减少胸腰椎椎弓根内固定术中的误差,提高手术的精确性。

Objective To assess the accuracy of computer navigation technology used in thoracolumbar pedicle screw fixation. Methods 15 cases with thoracolumbar lesions underwent orthopaedic operations. 72 pedicle screws were inserted with the computer navigation. After the operation, the position of the pedicle screw was evaluated with CT and X-ray using the Richter grading system. Results All cases succeeded with assistance of computer navigation. 15 eases were followed ：up for 6 to 24 months. No pedicle screw loosening or breakage was found. According to the location of the screw in X-ray and CT results,there was no vessel, nerve or spinal cord complication. According to Richter grading system, the results were excellent in 68 cases （94. 4% ） and good in 4 （5.6%）. It obviously reduced the radiation exposure to C-arm fluroscopy and the time that spend on surgery. It obviously improved the success rate of surgery. Conclusions C-arm navigation can obviously reduce error in thoracolumbar pedicle screw fixation and improve the accuracy of it.