O-arm三维计算机导航系统引导下置钉修复严重脊柱畸形的安全性

Safety of screw placement for severe spinal deformity with the use of O-arm three-dimensional computer-assisted navigation system

背景:O-arm导航综合了CT的图像质量,又有C型臂的灵活移动性。脊柱严重畸形手术难度大,神经损伤并发症高,是脊柱外科具有挑战性的手术。O-arm在脊柱畸形矫形中的作用显得尤为重要。目的:探讨O-arm导航系统引导下严重脊柱畸形的置钉效果及安全性。方法:回顾性分析25例O-arm导航下修复严重脊柱畸形患者的临床资料,观察并统计患者置钉情况、手术时间、术中出血量、脊柱侧凸、后凸改善情况,以评估置钉安全性。结果与结论:125例患者共置入椎弓根螺钉326枚,根据NEO分型,0级即没有穿破椎弓根皮质有280枚(92%);1级即穿破椎弓根皮质,但<2 mm有44枚(8%);2级即穿破椎弓根皮质>2 mm,但<4 mm有0枚(0%);3级即穿破椎弓根皮质>4 mm有0枚(0%)。2手术时间(272.3±17.3)min,术中出血量(1 710.0±229.1)m L;3治疗前侧凸Cobb角为(70.5±6.0)°,治疗后侧凸Cobb角为(22.8±4.8)°;治疗前后凸Cobb角为(72.0±5.2)°,治疗后后凸Cobb角为(28.1±5.7)°,差异均有显著性意义(P<0.05);4结果显示,在O-arm导航系统下修复严重脊柱畸形的置钉准确性高,降低了患者术中神经损伤的风险,侧凸、后凸畸形均得到了有效改善。

BACKGROUND：O-arm navigation integrates CT image quality and the flexible mobility of the C-arm.Surgery for severe spinal deformity is very difficult,with high incidence of nerve injury,so it is a challenging surgery for spinal surgery.The role of O-arm in the correction of spinal deformity is particularly important.OBJECTIVE：To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system.METHODS：Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed.We observed pedicle screw insertion,operation time,intraoperative blood loss,correction of scoliosis and correction of kyphosis,and assessed the safety of screw insertion.RESULTS AND CONCLUSION：（1） Totally 326 pedicle screws were implanted in 25 patients.According to NEO classification,280 pedicle screws（92%） belonged to grade 0（no perforation of pedicle cortex）.Grade 1：perforation of pedicle cortex, 2 mm,including 44 screws（8%）;grade 2：perforation of pedicle cortex, 2 mm, 4 mm,including 0 screw（0%）;grade 3：perforation of pedicle cortex, 4 mm,including 0 screw（0%）.（2） Operation time was（272.3±17.3） minutes.Intraoperative blood loss was（1 710.0±229.1） m L.（3） Cobb angle of scoliosis was changed from（70.5±6.0）° preoperatively to（22.8±4.8）° postoperatively.Cobb angle of kyphosis was changed from（72.0±5.2）° preoperatively to（28.1±5.7）° postoperatively.Significant differences were detected（P〈 0.05）.（4） These findings verify that with the guide of the O-arm navigation system,the accuracy of screw insertion is high.The risk of intraoperative nerve injury was reduced.The scoliosis and kyphosis deformity were improved effectively.