改良X线影像导航引导椎弓根钉内固定术在治疗腰椎滑脱症中的应用

Application of improved computer-assisted fluoroscopic navigation of to guide pedicle screw in treatment of lumbar spondylolisthesis

目的探讨改良二维X线影像导航模拟椎体三维影像的方式在引导椎弓根钉内固定术治疗腰椎滑脱症中的应用。方法对22例腰椎滑脱症患者行后路椎弓根钉固定撑开复位手术,术中采用X线影像导航的方法结合术前CT测量椎弓根夹角数据,获取多帧多方位的虚拟路径影像达到三维引导椎弓根钉植入效果。结果术中共植入88枚椎弓根钉。术后CT显示,全部椎弓根钉均位于椎弓根内,未出现涉及或突破皮质的现象。结论采用改良二维X线影像导航模拟椎体三维影像的方法引导腰段椎弓根钉内固定,达到三维导航在腰椎椎弓钉的植入效果,提高了置钉的准确性和安全性。

[ Objective ] To explore the clinical outcomes of using improved computer-assisted fluoroscopic navi- gation of imitation 3D vertebra image to guide pediele screw in lumbar spondylolisthesis. [ Methods ] Posterior pedi- cle screw internal fixation, distraction and reduction were performed in 22 patients with lumbar spondylolisthesis. Anterior posterior, lateral and oblique X-ray images of vertebrae were obtained by improved computer-assisted fluo- roscopic navigation, and subsequently anterior posterior, lateral spinal image and axial pedicle image were simulated to guide pedicle screw internal fixation. [ Results] Eighty-eight pedicle screws were implanted. Postoperative CT showed that all pedicle screws were situated within the pedicles without lateral or inner pedicle cortex invasion. [ Conclusions ] Improved computer-assisted fluoroscopic navigation through simulating 3D vertebra image for pedi- cle screw internal fixation guidance is convenient and effective method which improves the accuracy and safety of pedicle screw implants. There was no any complication.