O-Arm导航辅助在经皮椎弓根螺钉置入中的指导意义

Guiding significance of O-arm-based navigation in percutaneous pedicle screw implantation

目的探讨O-Arm导航在经皮椎弓根螺钉置入中的指导意义。方法回顾性分析2018-01—2020-01河南省人民医院脊柱外科行手术治疗的71例患者的临床资料,依据手术方法分为2组,A组采用O-Arm导航经皮椎弓根螺钉置入(34例,136枚椎弓根螺钉),B组实施C型臂X线机引导经皮椎弓根螺钉置入(37例,148枚椎弓根螺钉)。比较2组患者的基线资料。记录2组患者的置钉准确率、一次置钉成功率及并发症发生率,以及术前、术后1天、术后12个月时疼痛视觉模拟评分法(VAS)评分和Oswestry功能障碍指数(ODI)评分。结果2组患者的基线资料差异无统计学意义(P>0.05)。A组置钉准确率为96.3%,一次置钉成功率为97.8%,并发症发生率为8.82%,B组分别为89.8%、90.5%和27.03%,差异均有统计学意义(P<0.05)。2组患者术前的评分、ODI指数差异无统计学意义(P>0.05)。术后第1天及12个月时,2组患者的评分、ODI指数较术前显著改善;术后12个月时,2组患者的评分、ODI指数均较术后第1天显著改善。差异均有统计学意义(P<0.05)。A组患者术后第1天的评分、ODI指数明显优于B组,差异有统计学意义(P<0.05);但2组患者术后12个月时的评分、ODI指数差异无统计学意义(P>0.05)。结论C型臂X线机引导和O-Arm导航辅助经皮椎弓根螺钉置入术,对改善患者远期背痛及功能方面的疗效相当,但O-Arm导航辅助经皮椎弓根螺钉置入术能提高置钉准确率、一次置钉成功率和减少并发症发生率,近期效果明显。

Objective To explore the guiding significance of O-Arm navigation in percutaneous pedicle screw placement.Methods The clinical data of 71 patients who underwent surgery in Department of Spinal surgery of Henan people's Hospital from January 2018 to January 2020 were analyzed retrospectively.They were divided into 2 groups according to the surgical method.Group A underwent percutaneous pedicle screw placement in the O-Arm navigation group(34 cases,136 pedicle screws),and group B underwent C-arm X-ray fluoroscopy-guided percutaneous pedicle screw placement(37 cases,148 pedicle screws).Comparison of baseline data between the two groups of patients.The accuracy of nail placement,the success rate of nail placement and the incidence of complications in the two groups were recorded.And visual analogue scale(VAS)and ODI scores before the operation,1 day and 12 months post-operation.Results There was no significant difference in baseline data between the two groups(P>0.05).In group A,the accuracy of nail placement was 96.3%,the success rate of one-time nail placement was 97.8%,and the incidence of complications was 8.82%.The rates in group B were 89.8%,90.5% and 27.03% respectively,and the differences were all statistically significant(P<0.05).There was no significant difference in VAS and ODI index between the two groups before operation(P>0.05).At 1 day and 12 months after operation,the VAS and ODI index of the two groups were significantly improved compared with those pre-operation,and at 12 months post-operation,the VAS and ODI index of the two groups were significantly improved compared with the 1 day post-operation.The differences were statistically significant(P<0.05).The VAS and ODI index of the patients in the observation group on the 1 day post-operation were significantly better than those of group B(P<0.05).However,there was no significant difference in VAS and ODI index between the two groups at 12 months after operation.Conclusion C-arm X-ray machine fluoroscopy guidance and O-Arm navigation-assisted percutaneous pedicle screw placement are equally effective in improving long-term back pain and function,but O-Arm navigation-assisted percutaneous pedicle screw placement can improve the accuracy of screw placement,the success rate of primary screw placement and reduce the incidence of complications,and the short-term effect is obvious.