神经导航在脊柱固定手术中的应用

Clinical application of neuronavigation system in the spinal fixation surgery

目的：探讨应用神经导航系统进行椎弓根螺钉植入的优越性及近期疗效。方法在神经导航辅助下,对17例病人植入76枚椎弓根螺钉,记录单个椎体注册时间、钉道准备时间、术中出血量、术中“C”型臂照射次数、导航精度、术中螺钉重植次数及术后并发症；术后行CT检查评价椎弓根螺钉位置。结果平均单个椎体注册时间（6.3±2.1） min,平均钉道准备时间（2.6±1.3） min,平均术中出血量（253±70） ml；平均“C”型臂照射次数（3.5±0.5）；平均导航精度（0.9±0.1） mm。根据Richter法评估螺钉植入位置：优70枚,良5枚,差1枚；优良率98.68%。术中重植螺钉4枚,重植率5.26%。10例病人随访3～7个月,均无明显神经系统阳性体征。结论在神经导航辅助下,术者可以实时监测螺钉植入过程,前瞻性地判断植入椎弓根螺钉的大小、位置,使椎弓根螺钉植入有较高的准确性和安全性。

Objective To explore the superiority and short-term effect of the pedicle screws placement assisted by neuronavigation system in the spinal surgery. Methods Seventy-six pedicle screws were inserted into 17 patients under assistance by neuronavigation system. The single vertebral registration time, screw channel preparation time, intraoperative blood loss, times of Carm irradiation, accuracy of the neuronavigation, times of pedicle screw replacement and the complications were recorded. The locations of pedicle screws were evaluated by postoperative CT scan. Results The average single vertebral registration time was 6.3±2.1 min, average screw channel preparation time was 2.6±1.3 min, average intraoperative blood loss was 253±70 ml, average uses of C-arm was 3.5±0.5 times, and average accuracy of the neuronavigation was 0.9±0.1 mm. The assessment of pedicle screws location was carried out according to Richter method. In all the pedicle screws inserted, the result was excellent in 70 screws, good in 5 and bad in 1 screw, and the effectiveness rate was 98.68%. There were 4 pedicle screws reimplanted in the operation and the reimplantation rate was 5.26%. Ten patients were followed up for 3 to 7 months, and there were no positive neurological signs. Conclusions With the help of neuronavigation, the procedures of the insertion can be real-time monitored, and the size, location of the pedicle screws evaluated prospectively, which will improve the accuracy and security.