脊柱虚拟手术系统辅助下颈椎椎弓根置钉的临床评估

Clinical estimate on pedicle screw placement in lower cervical spine assisted by spinal virtual surgery system

目的:评价脊柱虚拟手术系统(spinal virtual surgery system,SVSS)辅助下行颈椎椎弓根置钉的准确性。方法:对收治的有术后多层螺旋CT(MSCT)复查资料的27例行椎弓根螺钉固定的下颈椎疾患病例,分为SVSS 3D技术辅助手术组(A组,10例)和MSCT 3D技术辅助手术组(B组,17例)。两组病例术前均行螺旋CT扫描,A组原始数据导出CT工作站,格式转换后导入SVSS系统行三维重建;B组原始数据直接在CT工作站行三维重建。两系统都选择VR和MPR重建,开展术前个体化评估以指导手术。术后螺旋CT复查评估置钉准确性,螺钉穿破评价参照Richter分级标准。结果:A组术后10例共50枚螺钉中44枚(88%)完全位于椎弓根内;6枚(12%)穿破椎弓根,其中1级穿破5枚(10%),2级穿破1枚(2%)。B组术后17例共76枚螺钉中67枚(88.16%)完全位于椎弓根内;9枚(11.84%)穿破,其中1级穿破6枚(7.89%),2级穿破3枚(3.95%)。两组间穿破率比较差异无显著性(P>0.05)。结论:SVSS可应用于实施术前个体化评估、个体化治疗方案制定及术后疗效评估和康复锻炼指导等。

Objectives： To evaluate the accuracy of pedicle screw placement in lower cervical spines assisted by spinal virtual surgery system（SVSS）. Methods： 27 patients scheduled for lower cervical pedicle screw placement were divided into group A（SVSS 3D-assisted pedicle screw placement, n=10） and group B（MSCT 3D- assisted pedicle screw placement, n=17）. All patients were examined by MSCT, and the data of group A were sent to SVSS, while the data of group B were sent to Silicon Graphics 02 Workstation. VR and MPR were used for reconstruction, which were used for individualized pedicle screw placement. MSCT scanning and 3D reconstruction was performed again to evaluate the accuracy of instrumentation. Richter perforation classification was used to evaluate screw perforation rate. Results： In group A, a total of 10 cases and 50 pedicle screws underwent MSCT scan after surgery, the rate of accuracy was 88%. According to the Richter perforation classification, a 10% was grade one, a 2% was grade two. In group B, a total of 17 cases and 76 pedicle screws underwent MSCT scan after surgery, the rate of accuracy was 88.16%. According to the Richter perforation classification, a 7.89% was grade one, and a 3.95% was grade two, no significant difference was noted between two groups（P〉0.05）. Conciusions： SVSS can be used for individualized patient review and screw placement, and even for evaluation of prognosis as well as rehabilitation.