3D导航联合神经监护在寰枢椎手术中的应用

The application of 3D navigation system combined with intraoperative neuroelectrophysiological monitoring in atlantoaxial surgery

目的探讨术中3D导航联合神经监护在寰枢椎手术中的应用价值。方法回顾分析接受寰枢椎后路椎弓根螺钉内固定手术且符合筛选标准的74例患者的临床资料,根据手术方案分组,其中透视组22例,导航组24例,导航联合监护组28例。通过对比3组患者术前术后JOA评分、NDI评分、手术时长、平均置钉时间、一级螺钉比例、术后并发症情况,分析3组患者临床疗效,置钉准确性及安全性等情况。结果导航联合监护组及导航组置钉准确率显著高于透视组,差异有统计学意义(P<0.05);术后3个月JOA评分及JOA评分改善率导航联合监护组高于另外两组(P<0.05),而NDI评分、平均置钉时间、术后并发症3组患者差异无统计学意义(P>0.05)。结论导航联合神经监护辅助寰枢椎手术能改善患者术后功能,增加手术安全性,提高手术疗效,同时能提高置钉准确率,并且不会延长置钉时间。

Objective To investigate the application of 3D navigation system combined with intraoperative neuroelectrophysiological monitoring （IONM） in atlautoaxial surgery. Methods From January 2011 to November 2016, 74 patients, who were treated with posterior atlantoaxial pedicle screw fixation at the Second Affiliated Hospital of Guangzhou Medical University, were divided into three groups, perspective group （n = 22）, navigation group （n = 24）, and naviga- tion combined with IONM group （n = 28）. The JOA score, NDI score, length of operation, average time of the pediele screw placement, ratio of first screw and postoperative complications were compared among the 3 groups. The clinical efficacy and the pediele screw placement accuracy were analyzed. Results The pedicle screw placement accuracy in naviga- tion combined with IONM group and navigation group are signicantly higher than the perspeetive group （ P 〈 0. 05 ）. The JOA score and JOA improvement ratio were significantly higher in navigation combined with IONM group than those in the other 2 groups 3 months after operation （ P 〈 0. 05 ）. However, there was no significant difference among the 3 groups in NDI score, average time of the pediele screw placement or postoperative complications. Conclusion Navigation combined with IONM for adantoaxial surgery can not only improve postoperative function of patients, increase surgical safety and improve the curative effect, but also improve the pediele screw placement accuracy without prolonging the time of the pediele screw placement.