O-arm导航系统在青少年特发性脊柱侧凸手术中的应用

目的探讨Oirm导航系统在治疗青少年特发性脊柱侧凸患者矫形手术中的应用效果方法回顾性分析2015年2月至2018年7月35例青少年特发性脊柱侧凸患者的临床资料,20例采用C形臂X线机辅助下徒手置钉(C臂机组),15例采用O-arm导航辅助置钉(O臂机组)。比较两组患者手术时间、术中出血量、置钉时间、螺钉密度及术后并发症术前、木后1个月及末次随访拍摄站立位脊柱全长正、侧位片,测量患者术前、术后及末次随访时冠状面Cobh角及其矫正率评价矫形效果术后所有患者行脊柱全长螺旋CT扫描评估椎弓根螺钉位置结果35例患者均获随访12〜48个月,平均(26.7±3.6)个月O臂机组手术时间(256.7±71.2)min,术中出血量(1525±557)mL;O臂机组手术时间(245.5±70.1)min,术中出血量(1389±489)mL;两组比较差异无统计学意义(P>0.05).O臂机组置钉时间(93.2±18.6)min,O臂机组置钉时间(76.3±14.1)min,两组比较差异有统计学意义(P<0.05)。C臂机组和O臂机组术后冠状面Cobb角分别为(21.1±5.2)°和(14.2±3.7)°,两组比较差异有统计学意义(P<0.05)末次随访时,C臂机组矫正丢失(5.9±2.6)°,O臂机组矫正丢失为(3.3±1.2)°,两组比较差异无统计学意义(P>0.05)。C臂机组20例患者置钉291枚螺钉,其中优145枚(49.8%),良102枚(35.0%),差44枚(15.1%),优良率84.8%;O臂机组15例患者置钉240枚螺钉,其中优168枚(70%),良58枚(24.1%),差6枚(2.5%),优良率94.2%;O臂机组置钉准确率高于O臂机组(P<0.05)。C臂机组螺钉密度为(51.2±14.7)%,O臂机组为(63.3±11.2)%,O臂机组螺钉密度高于C臂机组(P<0.05)。两组患者术后均无明显并发症。结论青少年特发性脊柱侧凸患者术中应用O-arm导航系统可有效缩短术中置钉时间,提高置钉准确率和螺钉密度,术后即时矫形效果好,同时未增加手术时间和术中出血量,安全性较好。

Objective To explore the applitadon of the three dimensional O-arm navigation system in treating patients with adolescent idiop«ithii scoliosis.Methods From February 2015 to July 2018,a total of 35 cases witli adolesc ent idiopathic scoliosis undergoing surgery were retrospec tively analyzed.There were 20 males and 15 females,with the mean age of 15.8 years(range,11-27 years).Depending on the surgical procedure,20 patients were treated with X-ray imehine(O-arm group)and 15 patients were treated with O-arm navigation system(O-ami group).Comparison of general data,perioperative and 1 month after postoperative conditions between the two groups.Results 35 patients were followed up by 12 months to 48 months(average,26.7 months).There was no significant difference in operatic^n time and intraoperative blood loss between the two groups(P>0.05).There was a statistically significant difference in the mean coronal Cobh angle and coronal correction loss between the two groups(P<0.05).There was a statistically significant difference in the good rate of implantation between the two groups(P<0.05).There was a statistically significant difference in the implant density between the two groups(P<0.05).Conclusion The three-dimensional O-arm navigation system can reduce implantation time,improve the s.ifety of pedicle screw inipl.intation,increase correction rate.Besides,the operative time and intraoperative blood loss are not increased,and the safety is good.