导航辅助下经皮椎弓根螺钉置入固定治疗胸腰段椎体骨折的临床疗效

Clinical outcomes of computer navigation assisted percutaneous pedicle screw internal fixation for thoracic-lumbar fractures

目的:评价计算机导航辅助经皮椎弓根螺钉内固定系统治疗胸腰椎骨折的安全性与准确性。方法:2013年1月~2016年1月我科收治40例胸腰椎骨折患者,其中胸椎25例,腰椎15例。其中T_(10)2例,T_(11)10例,T_(12)11例,L_110例,L_27例。男30例,女10例;年龄23~59岁。病例分为观察组和对照组,观察组采用计算机导航引导椎弓根螺钉内固定系统治疗,对照组采用传统开放椎弓根钉内固定术。分析手术的置钉安全性、准确性,手术时间,术中出血量及手术疗效等指标。根据视觉模拟(VAS)评分评估术后疼痛缓解情况。结果:术后随访3~24个月,中位随访时间为13个月。与对照组相比,术后VAS评分较术前均有改善(χ~2=5.469,P<0.05)。观察组术后未发现椎弓根螺钉松动、拔出、断钉。所有手术过程顺利,无血管、神经损伤并发症,螺钉大小选择合适。与对照组相比,观察组术中出血量少(t=5.052,P<0.05),术中透视次数均减少(t=9.070,P<0.05),手术时间缩短(t=3.613,P<0.05),但早期操作不熟练,时间较长,在置钉数量上差异无统计学意义(t=0.392,P>0.05)。结论:计算机导航辅助椎弓根内固定术治疗胸腰椎爆裂性骨折安全性和准确性较好,可减少术中出血量,疗效满意。

Objective:To evaluate the safety and accuracy of percutaneous pedicle screw internal fixation for the treatment of thoracic lumbar fractures using computer assisted surgical navigation(CASN)system.Methods:Forty cases of thoracic lumbar fractures treated in our department between January of2013and2016were included.Twenty five cases were thoracic fractures and15were fractures at lumbar vertebrae.The fractures occurred at T10in2cases,T11in10,T12in11,L1in10s,L2in7.Thirty cases were male,and10females.The patients aged from23to59years old,and were allocated to observational group and control group.Patients in the observational group received percutaneous pedicle screw internal fixation using CASN,and those in the control group were treated by open surgery with pedicle screw fixation.Two groups were evaluated regarding safe and accurate screw placemen,operative time,intra operative blood loss and surgical outcomes.Visual analogue score(VAS)was used to assess postoperative pain relief.Results:All patients were followed for3to24months(median13months).Patients in the observational group had significant postoperative pain relief as compared with the control group(χ2=5.469,P<0.05)as well as lower intra operative blood loss(t=5.052,P<0.05),fewer times for intra operative fluoroscopy(t=9.070,P<0.05),reduced operative time(t=3.613,P<0.05).Although no postoperative incidences of flexible screw placement,dislocation or broken screw occurred,and all patients were successfully undergone the operation,no damage to the blood vessels and nerve occurred and right size of screw was chosen,yet the difference was not significant in operating the system from unskillful in early stage to the time to skillful operation and the number of pedicle screws were placed(t=0.392,P>0.05).Conclusion:Percutaneous pedicle screw internal fixation with CASN system can improve the safety and accuracy of pedicle screw placement and reduce the intra operative blood loss,and lead to better treatment outcomes for thoracic lumbar fractures.