术中导航校准技术辅助下青少年特发性脊柱侧凸顶椎区置钉精确性研究

Accuracy of screw placement in the apical region of adolescent idiopathic scoliosis assisted by intraoperative navigation and calibration technology

目的:比较青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)顶椎区相同椎弓根类型在导航及导航校准技术辅助下置钉的精确性及偏出方向,并分析影响导航置钉偏移的相关因素及导航校准技术的临床意义。方法:回顾性分析自2017年10月~2020年10月,在我院明确诊断为AIS并在导航辅助下行经后路脊柱侧凸矫形内固定术治疗的41例患者,依据术中是否使用导航校准技术,将41例患者分为两组:导航组(n=22)和校准组(n=19)。收集两组患者基本信息,记录两组患者Risser征,术前、术后Cobb角,术后1年时矫形率,根据付长峰椎弓根分型系统对两组患者顶椎区椎弓根分型(A、B、C、D、E型),依据Rao分型评估两组相同椎弓根类型的置钉精确性。结果:校准组A、B、C型椎弓根优良置钉率(96.4%、87.8%、84.0%)显著高于导航组(79.2%、70.5%、56.7%),且凹凸双侧0级钉率显著高于导航组,同时校准组B型椎弓根及其凹凸双侧3级钉率(4.1%、2.0%6.3%)及C型椎弓根凸侧2级钉置钉率(11.1%)显著低于导航组(12.4%、11.1%、13.7%、50.0%),两组间差异均具有统计学意义(P<0.05)。此外,校准组A、B、C型椎弓根外侧皮质破壁率(33.3%、33.3%、60.0%)显著低于导航组(64.0%、38.6%、73.1%),同时校准组A型椎弓根椎体前壁穿破率(0.0%)及C型椎弓根凹侧外侧皮质破壁率(66.7%)显著低于导航组(24.0%、77.8%),而B型椎弓根内侧皮质穿破率(41.7%)高于导航组(40.9%),但其凹侧内侧皮质穿破率(36.4%)显著低于导航组(33.3%),两组间差异均具有统计学意义(P<0.05)。两组间均未发生脊髓、神经血管损伤等严重并发症。结论:与传统导航相比,导航校准技术在术中能够有效地预防导航偏移,显著提高AIS顶椎区A、B、C型椎弓根置钉精确性,降低误置螺钉外侧壁穿孔率及B型椎弓根凹侧内侧壁穿孔率,提高手术的安全性。

Objectives:To compare the accuracy and deviation direction of screw placement in the same pedicle type of apical vertebra of adolescent idiopathic scoliosis(AIS)with the aid of navigation and navigation calibration techniques,and to analyze the influencing factors of screw displacement under navigation and the clinical significance of navigation calibration technique.Methods:From October 2017 to October 2020,41 patients who were diagnosed with AIS in our hospital and were treated with posterior correction and internal fixation for scoliosis under the guidance of navigation were retrospectively analyzed.The patients were divided into navigation group(n=22)and navigation calibration group(n=19)according to whether applied navigation calibration technique.The basic information of the two groups of patients was collected,and the Risser sign,the Cobb angles before and after operation,and the postoperative correction rate were recorded.The types of pedicles of apical vertebrae of patients were classified according to the classification standard of Fu Changfeng(A,B,C,D,E),and the accuracy of screw placement of the same pedicle type was evaluated according to Rao classification.Results:The excellent and good screw placement rates of types A,B,and C pedicles in the navigation calibration group were 96.4%,87.8%,and 84.0%,which were significantly higher than those in the navigation group of 79.2%,70.5%,and 56.7%respectively,and the rates of grade 0 screws on both sides of the concave and convex in navigation calibration group was also significantly higher.The rates of grade 3 screw placement of B-type pedicle and its concave and convex bilateral sides in the calibration group and navigation group were respectively 4.1%and 12.4%,2.0%and 11.1%,6.3%and 13.7%,and the grade 2 screw rate of convex side of C-type pediclewas 11.1%and 50.0%,and the differences between the two groups were statistically significant(P<0.05).In addition,the perforation rates of the lateral cortex of types A,B,and C pedicles in the navigation calibration group were 33.3%,33.3%,and 60.0%,which were significantly lower than those in the navigation group of 64.0%,38.6%,and 73.1%.Meanwhile,in navigation calibration group,the anterior wall perforation rate of A-type pedicle was 0.0%and the perforation rate of the lateral cortex of the concave side of C-type pedicle was 66.7%,which were significantly lower than those of the navigation group of 24.0%and 77.8%.The perforation rate of the medial cortex of the B-type pedicle in navigation calibration group was 41.7%,which was higher than that in the navigation group of 40.9%,but the perforation rate of the concave medial cortex of 36.4%was significantly lower than 33.3%of the navigation group,and the differences between the two groups were statistically significant(P<0.05).None patients in both groups occurred serious complications such as spinal cord and neurovascular injury.Conclusions:Comparing with traditional navigation,the navigation calibration technology can effectively prevent navigation deviation during operation,improve significantly the accuracy of screw placement in types A,B,and C pedicles of AIS apical vertebrae,and reduce the perforation rates of lateral wall and concave medial wall of type B pedicleby screw misplacement,which may improve the safety of operation.