新型导航通道辅助经皮置钉治疗无神经损伤胸腰椎骨折

Novel guidance system assistance percutaneous pedicle screw placement for thoracolumbar vertebral fracture without nerve injury

目的比较新型导航通道下经皮置钉与传统透视下经皮置钉治疗长节段无神经损伤胸腰椎骨折的近期临床疗效。方法回顾性分析2010年9月至2012年12月38例胸腰椎骨折患者临床资料,按治疗方法将其分为A、B组。A组18例患者采用传统透视下经皮椎弓根置钉,共完成200枚椎弓根螺钉,B组20例患者采用新型导航系统辅助经皮椎弓根置钉,共完成210枚椎弓根螺钉,2组患者均由同一手术组人员完成手术。比较分析2组患者的置钉时间、射线暴露时间及置钉准确性,通过术后连续2次复查手术节段CT对2组患者置钉准确性进行评估并分级。结果 A组单根椎弓根螺钉平均置钉时间为(13.11±2.32)min,B组单根椎弓根螺钉平均置钉时间为(10.35±1.92)min,A组平均射线暴露时间为(13.07±2.06)s,B组平均射线暴露时间为(8.11±1.15)s,2组间在椎弓根置钉时间及射线暴露时间比较,差异有统计学意义(P<0.05)。A组患者有172枚(86.00%)螺钉被评定为A级;B组患者有185枚(88.09%)螺钉被评定为A级,2组患者在螺钉评定A级组间比较,差异无明显统计学意义(P>0.05)。结论新型导航通道下经皮置钉治疗长节段无神经损伤胸腰椎骨折能明显减少椎弓根螺钉置钉时间及辐射暴露时间,且置钉准确性与传统经皮置钉相近,效果良好。

Objective The aim of this study was to compare recent clinical efficacy between a novel guidance method for percutaneous pedicle screw placement and the conventional fluoroscopic method for long segments thoracolumbar vertebral fracture without nerve injury.Methods A total of 38 patients with thoracolumbar vertebral fracture in our hospital from September 2010 to December 2012 were divided into group A and group B. Eighteen patients in group A underwent 200 percutaneous pedicle screw fixation by conventional fluoroscopic method. Twenty patients in group B underwent 210 percutaneous pedicle screw fixation by a novel guidance method. All the operation for 38 cases were performed by the same surgeon. The time of insertion,radiation exposure,and accuracy of the screw placement between the two groups were compared. The accuracy of screws was evaluated and graded by two consecutive postoperative CT of operation segment for two groups.Results The mean time for a single pedicle screw placement was（ 13. 11 ± 2. 32） minutes in group A and（ 10. 35 ± 1. 92） minutes in group B,respectively. The average radiation exposure was（ 8. 11 ± 1. 15） s in group B and（ 13. 07 ± 2. 06） s in group A respectively. The differences were statistically significant for both screw placement and radiation exposure times（ P〈0. 05）. A total of 172 screws（ 86. 00%） in group A and 185 screws（ 88. 09%） in group B were perfectly located within the pedicle. The statistical difference of grade A between two groups was not significant（ P〈0. 05）. Conclusion The novel guidance system can significantly reduce the insertion time and radiation exposure for long segments percutaneous pedicle screw placement,which provides the same accuracy for screw placement compared with the conventional method.