O形臂导航辅助与徒手置钉治疗AO分型C型胸腰椎骨折的疗效比较

Comparison of efficacy of O‑arm assisted and free‑hand pedicle screw placement in the treatment of AO type C thoracolumbar fracture

目的比较O形臂导航辅助置钉与徒手置钉治疗AO分型C型胸腰椎骨折的疗效。方法采用回顾性队列研究分析2018年1月至2021年6月河南省人民医院收治的34例C型胸腰椎骨折患者临床资料,其中男23例,女11例;年龄42~63岁[(50.4±7.4)岁]。损伤节段:T_(11)4例,T_(12)10例,L_(1)12例,L26例,T_(11~12)、L_(1)1例,T_(12)、L_(1)1例。均采用后路复位内固定治疗,其中18例采用O形臂导航辅助椎弓根螺钉置入(导航组),16例采用徒手椎弓根螺钉置入(徒手组)。比较两组手术时间、单枚螺钉置入时间、术中出血量、手术方式及置钉准确率;比较两组术前、术后1周、术后3个月及末次随访时胸腰椎后凸Cobb角、视觉模拟评分(VAS)及美国脊髓损伤协会(ASIA)分级;观察术后并发症情况。结果患者均获随访12~29个月[(16.8±6.1)个月]。两组手术时间、术中出血量及手术方式差异无统计学意义(P均>0.05)。导航组单枚螺钉置入时间为(9.4±1.6)min,徒手组为(10.8±1.5)min(P<0.05);导航组置钉准确率为97.4%,徒手组为81.5%(P<0.01)。两组术前后凸Cobb角、VAS差异无统计学意义(P均>0.05)。术后1周导航组和徒手组后凸Cobb角分别为(4.3±1.1)°、(5.9±1.1)°,术后3个月分别为(4.4±1.2)°、(5.7±1.3)°,末次随访时分别为(4.4±1.2)°、(6.8±0.9)°,较术前的(21.8±3.1)°、(22.2±3.2)°明显降低(P均<0.01);术后1周、术后3个月及末次随访时导航组后凸Cobb角明显低于徒手组(P均<0.01)。术后1周导航组和徒手组VAS分别为(3.2±0.7)分、(4.1±0.7)分,术后3个月分别为(2.4±0.6)分、(3.0±0.8)分,末次随访时分别为(1.8±0.9)分、(2.6±0.7)分,较术前的(8.4±0.8)分、(8.3±0.9)分明显降低(P均<0.01);术后1周、术后3个月及末次随访时导航组VAS明显低于徒手组(P均<0.01)。术前、术后1周、术后3个月及末次随访时两组内和组间ASIA分级差异无统计学意义(P均>0.05)。术后导航组和徒手组分别有1例患者切口感染(P>0.05);导航组无内固定物松动、移位等内固定失效发生,徒手组2例患者出现内固定松动、移位(P>0.05)。结论与徒手置钉比较,O形臂导航辅助置钉治疗AO分型C型胸腰椎骨折具有置钉快速精准、复位良好、术后疼痛明显减轻等优点。

Objective To compare the effect of O⁃arm assisted and free⁃hand pedicle screw placement in the treatment of AO type C thoracolumbar fracture.Methods A retrospective cohort study was used to analyze the clinical data of 34 patients with type C thoracolumbar fracture admitted to Henan Provincial People′s Hospital from January 2018 to June 2021,including 23 males and 11 females;aged 42⁃63 years[(50.4±7.4)years].The fracture was located at T_(11) in 4 patients,T_(12) in 10,L_(1) in 12,L2 in 6,T_(11~12)/L_(1) in 1 and T_(12)/L_(1) in 1.Posterior reduction and internal fixation was carried out for all patients,of whom 18 were treated with O⁃arm assisted pedicle screw placement(navigation group)and 16 with free⁃hand pedicle screw placement(free⁃hand group).The operation time,single screw placement time,intraoperative bleeding volume,operation mode and screw placement accuracy were compared between the two groups.The kyphotic Cobb angle,visual analogue score(VAS)and American Spinal Injury Association(ASIA)score were compared between the two groups before operation,at 1 week after operation,at 3 months after operation and at the last follow⁃up.Postoperative complications were observed.Results All patients were followed up for 12⁃29 months[(16.8±6.1)months].There was no significant difference between the two groups in the operation time,intraoperative bleeding volume and operation mode(all P>0.05).The single screw placement time was(9.4±1.6)minutes in navigation group,but was(10.8±1.5)minutes in free⁃hand group(P<0.05).The screw placement accuracy was 97.4%in navigation group,but was 81.5%in free⁃hand group(P<0.01).The kyphotic Cobb angle and VAS had no significant differences between the two groups before operation(all P>0.05).The kyphotic Cobb angle in navigation group and free⁃hand group was(4.3±1.1)°and(5.9±1.1)°at 1 week after operation,(4.4±1.2)°and(5.7±1.3)°at 3 months after operation,and(4.4±1.2)°and(6.8±0.9)°at the last follow⁃up,decreased significantly from that before operation[(21.8±3.1)°,(22.2±3.2)°](all P<0.01).The kyphotic Cobb angle in navigation group was significantly lower than that in free⁃hand group at 1 week,3 months after operation and at the last follow⁃up(all P<0.01).The VAS in navigation group and free⁃hand group was(3.2±0.7)points and(4.1±0.7)points at 1 week after operation,(2.4±0.6)points and(3.0±0.8)points at 3 months after operation,and(1.8±0.9)points and(2.6±0.7)points at the last follow⁃up,decreased significantly from that before operation[(8.4±0.8)points,(8.3±0.9)points](all P<0.01).The VAS in navigation group was significantly lower than that in free⁃hand group at 1 week,3 months after operation and at the last follow⁃up(all P<0.01).The ASIA score showed no significant difference within and between the two groups before operation,at 1 week,3 months after operation and at the last follow⁃up(all P>0.05).Postoperative incision infection occurred in 1 patient in both groups(P>0.05).Implant failure such as loosening or displacement was not observed in navigation group,and only occurred in 2 patients in free⁃hand group(P>0.05).Conclusion Compared with free⁃hand pedicle screw placement,O⁃arm assisted pedicle screw placement in the treatment of AO type C thoracolumbar fracture has advantages of rapid and accurate screw placement,good reduction and notable pain relief.