影像导航行椎弓根钉加椎间钛笼融合治疗腰椎滑脱

Using Navigation Assisted Method for Treating Lumbar Spondylolisthesis with Inter-body Fusion with Pedical Screws and Cages

目的探讨脊柱影像导航系统引导椎弓根钉加椎间钛笼融合在腰椎滑脱症手术治疗中的临床意义。方法对80例腰椎滑脱患者在脊柱影像导航系统引导下利用椎弓根螺钉对滑脱椎体进行复位固定加椎管减压、椎间融合术。手术后对内植物和导航虚拟影像进行测量,疗效采用JOA下腰痛评分标准评定术前、术后分数,同时观察临床疗效及融合率。结果植入物实际影像图与导航虚拟手术路径图重叠,复查CT示内植物位置理想,椎弓根钉位置理想336枚(93%)。术后随访6～34个月,术前JOA评分平均7分,随访时为12.5分,优良率90%。结论影像导航系统引导椎弓根钉加椎间钛笼融合治疗腰椎滑脱症,植入前可以虚拟出内固定植入的手术环境和路径;植入中可以适时追踪手术器械的位置变化,使内植物精确植入最佳位置,提高了椎弓根钉和融合器植入的安全性,提高手术疗效。

Objective To explore outcomes and validity of using navigation assisted method for treating lumbar spondylolisthesis with inter-body fusion with pedical screws and cages. Methods 80 patients were treated by fixation and reduction method with pedicle screws and cages. All implants were guided by navigation assisted. After operation, the implants and navigation imaging were matched each other. Operative efficacy and fusion percent were judged by JOA grade system. Results Excellent correlation was observed in X ray image of the implants and virtual image of fluoroscopy. For pedicle screws, 336（93%） was excellent. After 6 months to 2 year and 10 months following-up, 90% of the patients obtained successful clinical outcome. Preoperative average JOA score was 7 and postoperative score was 12.5. Conclusion Using navigation assisted method for treating lumbar spondylolisthesis with inter-body fusion with pedical screws and cages can imitate the virtual image and entering path ,which also can pursue the position of the sur-gical instrument and then let the internal fixation approach to the precise position,increasing the security of implant.