无神经症状的胸腰椎骨折中O型臂导航下与传统经皮椎弓根置钉效果比较

Comparison of percutaneous pedicle screw placement under O-arm navigation with traditional percutaneous pedicle screw placement in patients with thoracolumbar fractures without neurological symptoms

目的比较无神经症状的胸腰椎骨折患者中O型臂导航下经皮椎弓根置钉与传统透视下经皮椎弓根置钉的准确性和临床疗效。方法回顾性分析2016年7月至2018年7月北京大学国际医院骨科72例无神经症状的胸腰椎骨折患者的临床资料,按照经皮椎弓根置钉方法分为A、B两组,传统透视下经皮椎弓根置钉为A组,36例患者共置入168枚椎弓根螺钉;采用O型臂导航下经皮椎弓根置钉为B组,36例患者共置入164枚螺钉。比较2组患者一般情况、手术情况、放射剂量和单枚螺钉透视时间、置钉时间和准确性、术后1周及术后6个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎后凸Cobb角、伤椎椎体前缘高度等指标。2组数据比较采用两独立样本t检验。结果两组患者一般情况、术中出血量、住院时间、VAS评分、ODI、伤椎后凸Cobb角、伤椎椎体前缘高度差异均无统计学意义(均P>0.05)。A组手术时间(99±14)min,B组为(75±10)min;A组单枚椎弓根螺钉置钉时间(15.8±2.6)min,B组为(11.8±3.3)min;A组的每枚螺钉透视时间为(38.0±2.0)s,B组为(28.5±2.8)s;A组的每台手术室内放射剂量为(563±163)cGy/cm^2,B组为(378±70)cGy/cm^2;B组上述指标均优于A组,2组差异均有统计学意义(t=8.48、5.73、16.30、6.25,均P<0.05)。A组螺钉置钉Rampersaud评分分级优于B组,2组差异有统计学意义(χ^2=12.2,P<0.05)。结论O型臂导航系统可以提供高清晰度导航图像并实现高精确度导航操作,较传统组置钉准确率更高,有利于脊柱稳定性的重建,同时能明显减少置钉和手术时间,辐射剂量更少。

Objective To investigate the accuracy and clinical efficacy of percutaneous pedicle screw placement under O-arm navigation and traditional fluoroscopy in patients with thoracolumbar fractures without neurological symptoms.Methods From July 2016 to July 2018,72 patients with thoracolumbar fractures in Peking University International Hospital without neurological symptoms were divided into two groups,group A and group B.In group A,36 patients underwent the surgery of percutaneous pedicle screw implantation under traditional fluoroscopy and 168 pedicle screws were inserted.In group B,36 patients underwent the surgery of percutaneous pedicle screw implantation under O-arm guided fluoroscopy and 164 pedicle screws were inserted by the same surgeon.The general condition,operation condition,radiation dose,fluoroscopy time of single screw,screw placement time and accuracy,visual analogue score(VAS)score,Oswestry dysfunction index(ODI),kyphosis Cobb′s angle,anterior edge height of 1 week and 6 months after surgery were compared.The data were compared with paired t test between the two groups.Results There was no significant differences between the two groups in general condition,intraoperative blood loss,length of hospital stay,VAS,ODI,kyphosis Cobb′s angle,and anterior edge height of the injured vertebra(all P>0.05).The operation time was(99±14)min in group A and(75±10)min in group B,the average screw setting time was(15.8±2.6)min in group A and(11.8±3.3)min in group B,the fluoroscopy time of each screw was(38.0±2.0)s in group A and(28.5±2.8)s in group B,the radiation dose of each surgery was(563±163)cGy/cm^2 in group A and(378±70)cGy/cm^2 in group B;the above-mentioned data of group A were all superior to those in group B and the differences between the two groups were all statistically significant(t=8.48,5.73,16.30,6.25,all P<0.05).Rampersaud grading in group A was better than group B,and the differences between the two groups was statistically significant(χ^2=12.2,P<0.05).Conclusion The O-arm navigation system could not only provide high-definition navigation images and achieve high-precision navigation operations,which is more accurate than traditional pedicle screws placement,but also contribute to the reconstruction of spinal stability and reduce radiation dose,pedicle screws placement and operating time.