腰椎骨折伤椎置钉中椎弓根螺钉可视化技术的应用

Application of pedical screw visualization technique in screw placement of lumbar vertebrae fracture

背景:三维可视化软件在临床治疗中的应用价值已经得到了普遍认可。医生可以应用术前可视化软件在复杂脊柱骨折模型上进行安全的演示以此获得经验,同时可以根据患者个性化的三维模型制定出个性化的螺钉置入方案。目的:观察置钉前应用可视化技术指导椎弓根螺钉内固定治疗短节段腰椎骨折脱位的临床效果。方法:纳入32例腰椎椎体骨折脱位患者,置钉前通过Mimics软件观察椎弓根完整性并测量置钉相关参数,通过置钉前重建三维影像向患者讲解置钉方式及相关并发症,共置入182枚椎弓根螺钉。评估患者知情同意满意度、手术时间、置钉后CT平扫螺钉的位置情况。测量置钉前、置钉后2周及置钉后8个月伤椎椎体前缘高度的比值和Cobb’s角,了解置钉后骨折复位情况以及随访期间有无内固定失败和复位丢失情况。结果与结论:患者知情同意非常满意者占100%,手术时间平均185 min,置钉后CT平扫173枚螺钉(95.1%)完全位于椎弓根内,经随访7-22个月,患者骨折均达到临床骨性愈合。置钉后2周伤椎椎体前缘高度、Cobb’s角均较置钉前有显著改善(P<0.05),置钉后8个月伤椎椎体前缘高度和Cobb’s角与置钉后2周差异无显著性意义(P>0.05)。提示通过伤椎椎弓根钉道可视化技术能够有效指导治疗单一节段腰段骨折。这种方法可使医生进行术前计划,提高患者的病情知情同意满意率,缩短手术时间,提高置钉后螺钉位置满意度。

BACKGROUND： Three-dimensional visualization technique has been widely used in clinical treatment. Preoperative visualization technique allows safe demonstration on the complex spine fracture models, and also prepare screw placement scheme according to three-dimensional model of patients. OBJECTIVE： To discuss the clinical result of treating short-segment lumbar vertebrae fracture with pedicle screw visualization. METHODS： A total of 32 patients with lumbar vertebrae fracture were treated with 182 pedicle screws. Before the screw implantation, the structure of bilateral pedicle was observed using Mimics software and the implantation parameters were measured. The operation methods and related complications were told to the patients through the reconstructed three-dimensional images. The satisfaction of the patients, operation time, and the position of pedicle screws by postoperative CT scan were assessed. The percentages of anterior vertebral height and Cobb＇s angle were measured before operation, 2 weeks after operation and 8 months after operation. RESULTS AND CONCLUSION： The excellent satisfaction rate of the patients was 100%, the mean operation time was 185 minutes, and 173 pedicle screws （95.1%） were totally inserted within the pedicle. All patients were followed up for 7-22 months. The results showed that the fracture healed well. The percent of anterior vertebral height and Cobb＇s angle at 2 weeks after operation were significantly decreased compared with them before operation （P 〈 0.05）. There were no significant difference about the percent of anterior vertebral height and Cobb＇s angle between 2 weeks and 8 months follow-up （P 〉 0.05）. Single-segment lumbar vertebrae fracture was well treated by the pedicle screw visualization technique. This method assists to make up preoperation plan, increase the rate of patients＇ satisfaction, shorten operation time, and increase the accuracy of pedicle screw insertion.