电子导航置钉与传统徒手置钉在脊柱侧弯顶椎区域应用的临床对比研究

Clinical comparison of the pedicle screws implantation in apical area between electronic conductivity device and free-hand technology in spinal surgery of scoliosis

目的:对比基于椎体生物电阻抗的电子导航开路器(electronic conductivity device,ECD)与传统徒手操作(free hand,FH)在脊柱侧弯顶椎区域置钉矫形过程中的准确性差异。方法:2016年4月至9月第二军医大学附属长海医院收治的4 8例脊柱侧弯患者,其中男7例,女4 1例,年龄(15.2±2.6)岁;主弯Cobb角平均值58.3°±9.0°,随机均分两组,在顶椎区域置钉矫形过程中,两组分别采用传统的徒手开路和ECD的手段进行置钉,分别记录两种方法的置钉时间、电透次数及螺钉穿孔率,进而对比两种手段置钉的优缺点。结果:所有手术均顺利完成,没有神经血管损伤及术后并发症的发生。ECD组有4枚螺钉(2.5%),FH组11枚螺钉(7%)置入位置不理想,两组差异有统计学意义(P=0.010);顶椎区平均置钉时间ECD组为(2.7±0.4)min,FH组为(3.2±0.6)min,差异无统计学意义(P=0.073);术中平均透视次数ECD组为(3.3±0.7)次,FH组为(5.5±0.8)次,两组差异有统计学意义(P=0.034)。结论:基于椎体生物电阻抗的ECD相比于传统的FH,可以提高脊柱侧弯顶椎区域置钉的准确性,有利于减少术者及患者术中X线的辐射量。

Objective： To compare the clinical outcome and safety ofpedicle screws implantation in apical area of scoliosis between electronic conductivity device （ECD） and free-hand （FH） technology. Methods： From April 2016 to September 2016, 48 patients of spine deformity, including 7 male and 41 female, aged （15.2±2.6） years, with average major Cobb angle of 58.3°±9.0°, were treated with posterior surgery. They were randomly divided into 2 groups： group ECD and group FH. The 2 groups were compared for accuracy of screw placement in apical area,time for screw insertion and the number of times the C-arm had to be brought into the field. Results： None of these patients had any clinical evidence of neurovascular involvement, qhere were 4 （2.5%） pedicle perforation in the ECD group compared with 11 （7.0%） in FH group, the difference was statistically significant （P=0.010）. The average time of screws placement in apical area： ECD group was （2.7±0.4） min, and （3.2±0.6） min in FH group, there was no significant difference （P=0.073）. The average radiation quantity： ECD group were （3.3±0.7） times and FH group were （5.5±0.8） times, the difference was statistically significant （P=0.034）. Conclusion： Comparing with FH technology, ECD can increase the accuracy ofpedicle screws in apical area and reduce the radiation for doctors and patients.