X射线透视辅助徒手法与CT三维图像导航下颈椎椎弓根置钉准确率的对比

Accuracy of X-ray fluoroscopy versus CT three-dimensional image navigation in cervical pedicle screw insertion

背景:临床上颈椎椎弓根导航方法相对较多,均能提高围术期置钉准确率,但是这些导航系统尚存在许多不完善之处,如图像质量不高、操作复杂繁琐、实时性差或导航存在创伤性等,难以达到预期的置钉效果。目的:对比X射线透视辅助徒手法与CT三维图像导航下颈椎椎弓根置钉的准确率。方法:取南阳医学高等专科学校第一附属医院收治的颈椎椎弓根置钉患者90例,随机分为2组(n=45),徒手组在X射线透视辅助下徒手法置入132枚颈椎椎弓根螺钉,三维导航组在CT三维图像导航下置入128枚颈椎椎弓根螺钉,记录2组置钉时间、出血量;2组术后均行CT平扫,完成三维重建,比较2组颈椎椎弓根螺钉置钉准确率。结果与结论:(1)三维导航组围术期置钉优良率95.3%显著高于徒手组88.6%(P<0.05);(2)三维导航组置钉时间显著长于徒手组(P<0.05),置钉出血量显著多于徒手组(P<0.05),导航匹配时间及辐射量小于徒手组(P<0.05);(3)2组术前JOA评分比较差异无显著性意义(P>0.05);三维导航组术后3,6个月JOA评分均显著高于徒手组(P<0.05);(4)三维导航组并发症发生率7%低于徒手组16%(P<0.05);(5)结果提示,与X射线透视辅助徒手法置钉相比,CT三维图像导航能提高颈椎椎弓根置钉准确率,提高手术安全和精确性。但是CT三维图像导航置钉方法操作相对繁琐,耗费时间较长,造成患者术中出血量较大,应根据患者情况选择合适的置钉方法。

BACKGROUND： Navigation systems all can improve the accuracy rate in cervical pedicle screw insertion, but cannot achieve desired outcomes because of some shortcomings, such as poor imaging quality, complicated operation, poor real-time performance, and invasive navigation.OBJECTIVE： To study the accuracy of X-ray fluoroscopy and CT three-dimensional image navigation in cervical pedicle screw insertion.METHODS： Totally 90 patients undergoing cervical pedicle screw insertion from the First Affiliated Hospital of Nanyang Medical College were enrolled, and randomly divided into control and experimental groups （n=45 per group）. 132 cervical pedicle screws were inserted into the patients in the control group manually under X-ray fluoroscopy, and 128 ones were inserted into the patients in the experimental group assisted with CT three-dimensional image navigation. The operation time and intraoperative blood loss in the two groups were recorded. Postoperative CT three-dimensional reconstruction was performed to compare the placement accuracy between two groups.RESULTS AND CONCLUSION： The excellent and good rate of placement in the experimental group （95.3%） was significantly higher than that in the control group （88.6%, P 〈 0.05）. （2） The operation time and intraoperative blood loss in the experimental group were significantly higher than those in the control group, and the navigation matching time and radiant quantity in the experimental group were significantly less than those in the control group （P 〈 0.05）. （3） The Japanese Orthopedic Association scores showed no significant difference between two groups before surgery （P 〉 0.05）,and were significantly improved in the experimental group compared with the control group at 3 and 6 months postoperatively （P 〈 0.05）. The incidence of complications in the experimental group was significantly lower than that in the control group （7% versus 16%, P 〈 0.05）. （5） These results suggest that compared with X-ray fluoroscopy, CT three-dimensional image navigation can improve the accuracy of cervical pedicle screw insertion, showing higher safety and precision. However, it needs complicated operation skills, and long operation time results in massive intraoperative blood loss; thereafter, choosing which placement method depends on the patient condition.