Iso-C臂三维导航系统指导下的脊柱侧弯椎弓根钉内固定:问题与优势

Pedicle screw fixation for scoliosis using Iso-C arm three-dimensional navigation: problems and advantages

背景:由于脊柱侧弯患者脊柱解剖结构的变异、椎体旋转、椎体缺如、椎管变形等异常情况,椎弓根螺钉一旦置入发生偏差,即可导致灾难性结果。近年来随着椎弓根螺钉的广泛应用和计算机导航的不断发展,使脊柱侧弯修复手术更加精确、安全。目的:综述Iso-C臂三维导航系统指导脊柱侧弯椎弓根钉置入内固定存在的问题及优势。方法:由第一作者检索至2012年12月为止Pub Med数据(http://www.ncbi.nlm.nih.gov/Pub Med)及CNKI中国期刊全文数据库(http://www.cnki.net/),以"计算机导航,脊柱侧弯,椎弓根钉"为检索词,检索摘要内同时包含上述检索词的文献。共检索到50多篇相关文献,13篇文献符合纳入标准。结果与结论:应用Iso-C臂三维导航系统进行脊柱侧弯椎弓根螺钉置入内固定具有显著优势。它充分结合了CT三维导航和术中透视导航的优点,可快速、准确的采集术中影像数据,通过影像实时显示,从而确保修复手术的安全。Iso-C臂三维导航其自动注册的功能无疑提高了修复效率和精确性,帮助术者以更加精确、安全的方式进行各种复杂的脊柱侧弯修复手术。

BACKGROUND： Due to variation of spinal anatomic structure, vertebral body rotation, absence of vertebral body, and spinal canal deformation in patients with scoliosis, the deviation of pedicle screw placement can induce catastrophic results. Recently, with the wide application of pedicle screw and the continuous development of computer navigation, scoliosis surgery becomes more accurate and safe. OBJECTIVE： To review the existing problems and advantages of Iso-C arm three-dimensional（3D） navigation system for guiding internal fixation of pedicle screw implantation in the treatment of scoliosis. METHODS： The first author searched Pub Med（http：//www.ncbi.nlm.nih.gov/Pub Med） and CNKI（http：//www.cnki.net/） for articles published until December 2012. The key words were ＂computer navigation, scoliosis, pedicle screw＂. The literatures with abstracts containing above key words were retrieved. Totally more than 50 articles were found, and 13 articles were accorded with the inclusion criteria. RESULTS AND CONCLUSION： Iso-C arm 3D navigation system for guiding internal fixation of pedicle screw implantation in the treatment of scoliosis had obvious advantages. It fully combined the advantages of CT 3D navigation and intraoperative X-ray navigation, and can quickly and accurately capture the image data. Real time display of images could ensure the safety of repair operation. Automatic registration function of Iso-C arm 3D navigation undoubtedly improves the efficiency and accuracy of the repair, and helps physicians with more accurate and safe ways to carry out a variety of complex scoliosis surgery.