CT导航系统在重度僵硬性脊柱畸形矫形术中的置钉准确性及临床疗效评估

Evaluation of the Accuracy of Screw Placement and Clinical Efficacy of Intraoperative CT Navigation System in Severe Rigid Spinal Deformity

目的 评估CT导航系统在重度僵硬性脊柱畸形矫形术中的置钉准确性及临床疗效。方法 回顾性纳入2017年1月至2022年12月我院收治的43例重度僵硬性脊柱畸形病人,其中21例采用术中CT导航系统辅助置钉(421枚螺钉)的病人纳入导航组,22例采用传统徒手置钉(386枚螺钉)的病人纳入徒手组。收集两组病人的一般资料、手术前后主弯Cobb角、矫正率、置钉数量以及顶椎区域置钉数量。采用Gertzbein和Robbins分级分析两组病人术后CT图像,以评估置钉准确性。结果 两组病人手术前后主弯Cobb角及矫正率比较,差异无统计学意义(P>0.05)。较之徒手组,导航组置入于顶椎区域的螺钉数量更多[(7.37±1.12)个vs.(6.45±0.96)个],手术时间更长[(376.19±56.26) min vs.(331.36±50.92) min],差异均有统计学意义(P<0.05);但出血量无明显差异(P>0.05)。两组病人总体置钉准确率比较,差异无统计学意义(P=0.586);但在顶椎区域,导航组置钉准确率显著高于徒手组(96.1%vs.89.4%,χ^(2)=5.051,P=0.025)。此外,术中CT导航系统明显降低了椎弓根内侧穿孔率(χ^(2)=5.122,P=0.024)。结论 CT导航系统可有效提高重度僵硬性脊柱畸形顶椎区域的置钉准确性。

Objective To evaluate the accuracy of screw placement and clinical efficacy of CT navigation in severe rigid spinal deformity correction surgery.Methods A total of 43 patients with severe rigid spinal deformity were treated retrospectively from January 2017 to December 2022,among them,421 pedicle screws in 21 cases were included in the navigation group,and 386 pedicle screws in 22 cases were in the freehand group.General data of the two groups,the preoperative main curve Cobb angle,postoperative main curve Cobb angle,the correction rate,the number of screws and the number of screws in apical region were collected.Postoperative CT images were analyzed by Gertezbin and Robbins classification criteria to assess the accuracy of screws.Results There were no statistically significant differences in preoperative main curve Cobb angle,postoperative main curve Cobb angle and correction rate between two groups(P>0.05).The number of screws placed in the apical region was greater[(7.37±1.12)vs.(6.45±0.96)],and the operation time was longer[(376.19±56.26)min vs.(331.36±50.92)min]in the navigation group than in the freehand group(P<0.05),but there was no significant difference in blood loss(P>0.05).There was no statistically significant difference in the accuracy of pedicle screw placement between two groups(P=0.586).However,in the apical region,the accuracy of pedicle screw placement was significantly higher in the navigation group than that in the freehand group(96.1%vs.89.2%,χ^(2)=5.051,P=0.025).Moreover,CT navigation significantly diminished medial perforation(χ^(2)=5.122,P=0.024).Conclusion Intraoperative CT navigation system can effectively improve the accuracy of screw placement in the apical region of severe rigid spinal deformity.