O型臂联合实时导航技术在脊柱内固定术中的应用

Study on the accuracy of O-arm combined with real-time navigation technology in spinal fixation

目的 探讨O型臂（O-arm）联合实时导航技术在脊柱内固定术中的适用性和精准性.方法 回顾性分析清华大学附属北京清华长庚医院神经外科2015年5月至2016年5月收治的31例脊柱内固定患者的临床资料,评估术前、术中和术后的影像学表现.根据病变的手术范围分为枕颈融合组（19例）和胸腰骶椎弓根内固定组（12例）,病变均在显微镜下切除,内固定在O-arm联合实时导航辅助下进行,术中进行神经电生理监测.根据手术时间、透视次数、螺钉位置和并发症情况评价疗效.结果 枕颈融合组19例患者中,共行颈椎植钉112枚,枕骨植钉57枚,术中三维影像显示有2枚穿破侧块皮质临近椎动脉;胸腰骶椎弓根内固定组12例患者中,共行椎弓根螺钉植入72枚,术中2枚椎弓根螺钉穿透到椎体外,术中及时矫正位置.O-arm扫描次数平均为3次/例;O-arm及导航操作时间每次为20 ～ 30 min;每枚螺钉植入的平均时间：颈椎5～7 min、胸椎8～ 10 min、腰椎6～8 min.结论 O-arm实时导航螺钉植入可实时观察螺钉的角度和深度,大大提高了植入的精准度和安全性,同时降低了术者和患者的辐射剂量和次数.

Objectives To explore the applicability and precision of O-arm combined with real-time navigation technique in spinal fixation.Methods The clinical data of 31 inpatients with spinal fixation were retrospectively analyzed at Department of Neurosurgery,Beijing Tsinghua ChangGung Hospital from May 2015 to May 2016.Preoperative,intraoperative and postoperative imaging findings were assessed.The patients were divided into occipitocervical fusion group （19 cases） and thoracic-lumbar-sacral spine fixation group （12 cases）.The lesion resection was performed under microscope.O-arm combined with real-time navigation was used in spinal fixation.Surgical efficacy in the patients was evaluated by means of operation time,X-ray times,screw positions and complications.Results During the occipitocervical fusion group,112 screws were implanted in the cervical spine,and 57 in occipital bones.Two screws were found to have penetrated bone cortex and were adjacent to vertebral arteries according to intraoperative 3-D image of O-arm.In the thoracic-lumbar-sacral spine fixation group,72 pedicle screws were implanted,but 2 screws were out of vertebral body and corrected in time.O-arm scan times was 3 per case on average,and the operation time of O-arm and navigation was 20-30 minutes per time.Screw implantation lasted 5-7 minutes per screw in cervical spine,8-10 minutes in thoracic and 6-8 minutes in lumbar spine.Conclusions Through O-arm real-time navigation,the angle and depth of screws could be observed in real during screw implantation,which would greatly improve the implantation accuracy and safety,and,at the same time,reduce the radiation dose and times for the patients.