术中导航漂移校准技术对Lenke 1型青少年特发性脊柱侧凸顶椎区置钉精度的影响

Accuracy of screw placement in the apical region of Lenke 1 adolescent idiopathic scoliosis surgery using a calibration technique for the intraoperative navigation error

目的:研究Lenke 1型青少年特发性脊柱侧凸(Adolescent idiopathic scoliosis,AIS)顶椎区在术中导航漂移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漂移校准技术的临床意义。方法:分析2017年~2020年行三维矫形术的Lenke 1型AIS患者60例,其中导航辅助置钉30例(导航组),术中导航漂移校准技术辅助置钉30例(导航校准组)。收集两组患者的基本信息和影像学资料,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,并依据Rao分型评估两组间置钉的精确性。结果:两组间共置入600枚螺钉,导航组297枚,导航校准组303枚。导航校准组A、B、C型椎弓根0级椎弓根螺钉置钉率分别为95.7%、86.7%与68.9%,显著高于导航组的73.9%、66.9%与30.0%,两组间差异均具有统计学意义(P<0.05)。此外,导航校准组A、B、C、D型椎弓根螺钉穿破内侧皮质率分别为0%、1.6%、1.6%与0%,低于导航组的16.3%、16.9%、30.0%与47.6%。同时,在顶椎区凹侧导航校准组A、B、C、D型椎弓根置入螺钉穿破内侧皮质率为0%、3.6%、2.6%与0%,显著低于导航组的34.4%、25.9%、37.2%与60%,两组间差异具有统计学意义(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:与单纯导航相比,术中导航漂移校准技术可提高重度Lenke 1型AIS顶椎区置钉精度,降低内侧皮质穿破率,减少凹侧椎弓根误置率,增加重度AIS患者顶椎区置钉安全性。

Objective:To study the position and the grade of screw perforation in the apical region of adolescent idiopathic scoliosis(AIS)surgery using a calibration technique for the intraoperative navigation error,and to analyze the related factors of navigation deviation and the clinical significance of the calibration technique.Methods:From 2017 to 2020,a total of 60 Lenke 1 AIS surgical cases were enrolled in this research.The 30 cases received surgery using the intraoperative navigation system(Navigation group)and another 30 cases were assisted with intraoperative navigation system with calibration technique(Calibration group)for the intraoperative navigation error.The basic information and radiological data of the both groups were all recorded.According to the Fu Chang‑feng’s pedicle channel classification system,the pedicle on the apical region of the two groups was classified.And then the accuracy of screw placement of the two groups was evaluated according to the Rao’s classification.Results:A total of 600 screws were placed in the two groups.The 297 and 303 pedicle screws were implanted in the navigation group and the calibration group,respectively.In the apical region of the calibration group,the rates of the grade 0 screw placement in type A,B and C pedicle were 95.7%,86.7%and 68.9%respectively.It was a statistically significant difference from the 73.9%,66.9%and 30.0%in the navigation group respectively(P<0.05).In the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,1.6%,1.6%and 0%,respectively.The corresponding rates were 16.3%,16.9%,30.0%and 47.6%in the navigation group,respectively.Moreover,in the concave side of the apical region of the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,3.6%,2.6%and 0%,respectively.Compared with the calibration group,the corresponding rates were higher in the navigation group(34.4%,25.9%,37.2%and 60.0%,respectively).No serious complications such as spinal cord or neurovascular injury occurred for the two groups.Conclu⁃sion:Compared with the intraoperative navigation system,the calibration technique for the intraoperative navigation error could provide the higher accuracy of pedicle screw placement in the apical region of the major curve,the lower medial cortical perforation rate,the less screws misplacement rate on the concave side and the less complication rate of the severe Lenke 1 AIS patients.