O-arm导航辅助下后路半椎体切除治疗先天性脊柱侧后凸畸形

Application of intraoperative O-arm navigation in posterior hemivertebra resection for treatment of congenital kyphoscoliosis

目的探讨术中O-arm导航辅助下后路半椎体切除治疗半椎体所致先天性脊柱侧后凸畸形的应用价值。方法回顾性分析河北医科大学第三医院脊柱外科2014年1月—2叭5年3月收治的14例半椎体所致先天性脊柱侧后凸畸形患者的临床资料，其中男5例、女9例，年龄9～15岁。患者均为单发性完全分节半椎体畸形，其中半椎体位于T9 1例、T102例、T11 5例、T12 3例、L1 2例、L2 1例。患者术前均拍摄站立位全脊柱正、侧位X线片，测量冠状面及矢状面Cobb角。在O—arm导航辅助下植入椎弓根螺钉，术中O-grill导航3D重建半椎体畸形，明确半椎体切除范围，彻底切除半椎体畸形。术中经O-arm扫描、术后经CT扫描观察螺钉位置；分析手术前后Cobb角，评价脊柱侧凸、后凸矫正率。结果14例患者共置入椎弓根螺钉120枚，其中11例置入4对椎弓根螺钉，2例置入5对，1例置入6对；经术中O-arm扫描确认位置良好，术后CT扫描评估螺钉置入准确性：0级118枚（98．3％），1级2枚（1．7％）。本组病例手术时间平均为（195．4±17．4）min，术中出血量平均为（611．9±173．0）mL，术后随访3～15个月，平均9．6个月。术前侧凸Cobb角为62．8°±15．8°，术后为10．9°±5．3°，矫正率为83．34％±6．08％，末次随访时为12．1°±4．8°；术前后凸Cobb角为57．5°±15．5°，术后为17．0°±6．6°，矫正率为70．66％±6．79％，末次随访时为17．9°±7．0°。随访期间未见明显角度丢失。术后与末次随访时侧凸、后凸角度与术前比较，差异均有统计学意义（P值均〈0．01）；而术后与末次随访时比较，差异均无统计学意义（P值均〉0．05）。本组病例术后无神经并发症，未发生螺钉松动、脱出、折断等。结论在后路半椎体切除治疗先天性脊柱侧后凸畸形的手术中，O-arm导航能够指导椎弓根螺钉的准确置入和半椎体的精准切除，减少手术并发症，提高手术安全性。

Objective To investigate the value of intraoperative O-arm navigation in posterior hemivertebra resection for treatment of congenital kyphoscoliosis caused by fully segmented hemivertebr. Methods From January 2014 to March 2015, a total of 14 patients with congenital kyphoscoliosis caused by fully-segmented hemivertebra who had undergone hemivertebra resection surgery at the Third Hospital of Hebei Medical University were reviewed retrospectively. There were 5 males and 9 females with an average of 11.9 years （ranged from 9 to 15 years）. Among them, the hemivertebra were located at T9, L2 in each 1 patients, T10, L1 in each 2 patients, T12 in 3 patients, TH in 5 patients. Full-length standing radiographs were taken before surgery. The Cobb angle in the coronal and sagittal plane were measured and analyzed. All pedicle screws insertion was performed guided by intraoperative O-arm navigation. According to the comparison of intraoperative O-arm navigation in three-dimensional reconstruction of the hemivertebra, the scope of hemivertebra resection could be determined, and then individualized, thoroughly and effectively resected the hemivertebra. The screw position was observed by O-arm scan in operation and CT scan after surgery. And the pre- and post-operative changes of the Cobbs angle were analyzed in order to evaluate the correction rate of scoliosis and kyphosis. Results All the 120 screws for 14 patients were inserted exactly. The surgery time was （ 195.4 ± 17.4） min and blood loss was （611.9 ± 173.0） mL. All the patients were followed up from 3 to 15 months（average 9.6 months）. Scoliosis angle was corrected from 62.8° ± 15.8° to 10.9° ± 5.3°with a correction rate of 83.34% ± 6.08%. At the last follow-up, the scoliosis angle was 12.1°±4.8° with no significant loss of correction. Kyphosis angle was corrected from 57.5°±15.5° to 17.0°± 6.6° with a correction rate of 70.66% ± 6.79%. At the last follow-up, the kyphosis angle was 17.9°± 7. 0° with no significant loss of correction. They were compared pre- and post-operative respectively, with significant differences （ all P values 〈 0. 01 ）. However, there were no significant differences between postoperative and the final follow-up （ all P values 〉 0.05 ）. No implants failure and correction lost were found during the follow-up. Conclusions In posterior approach hemivertebra resection for congenital kypho scoliosis patients caused by fully segmented hemivertebr, the use of intraoperative O- arm navigation can make screws insertion more accurate and safe. And resection of the hemivertebr is more accurate. In this way, it can reduce the complications and improve the safety of operation.