O形臂导航辅助经皮椎弓根螺钉内固定的初步应用

Primary application of percutaneous pedicle screw fixation under O-arm navigation

目的探讨O形臂导航辅助经皮椎弓根螺钉内固定的准确性与安全性。方法回顾性分析7例经皮椎弓根螺钉内固定病人的临床及影像学资料。病人均在置钉结束后行O形臂系统3D扫描,按照Gertzbein-Robbins分级评估置钉的准确性。结果 7例病人在O形臂导航辅助下共置入29枚椎弓根螺钉,其中Gertzbein-Robbins分级A级23枚(79.31%),B级4枚(13.79%),C级1枚(3.45%),E级1枚(3.45%)。手术共置入29枚克氏针,其中1枚(3.45%)突破椎体前缘。术中无关节突关节受到破坏。1例出现置钉相关神经并发症行再次手术调整椎弓根螺钉。随访(8.29±2.43)个月,无钉棒置入后相关并发症。结论 O形臂导航辅助经皮椎弓根螺钉内固定具有较高的准确性及安全性。

Objective To explore the accuracy and safety of percutaneous pedicle screw fixation under O-arm navigation. Methods Clinical and imaging data of 7 patients undergoing percutaneous pedicle screw fixation were analyzed retrospectively.Three-dimensional scan with O-arm system was performed after fixation in all the patients, and the accuracy of screw placement was evaluated according to the Gertzbein-Robbins grade. Results A total of 29 percutaneous pedicle screws were inserted in 7 patients under O-arm navigation, including Gertzbein-Robbins grade A in 23 screws（79.31%）, grade B in 4（13.79%）, grade C and E in 1（3.45%） each. While 29 kirschner wires were inserted, and 1 kirschner wire（3.45%） broke through the anterior vertebral body. No zygapophyseal joint was damaged during the operation. The screw-related neurovascular complication occurred in 1 patient and returned to operating for screw revision. During a follow-up period of 8.29 ± 2.43 months, no screw-related complication occurred.Conclusion Percutaneous pedicle screw fixation under O-arm navigation is accurate and safe.