新型点状接触式椎弓根导航模板在脊柱侧弯矫形术中辅助植钉的应用研究

Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery

目的探讨新型点状接触式椎弓根导航模板(以下简称“新型导板”)在脊柱侧弯矫形术中辅助植钉的效果。方法以2020年2月—2023年2月收治且符合选择标准的25例脊柱侧弯患者作为试验组,矫形术中采用3D打印新型导板辅助植钉;按纳排标准匹配2019年2月—2023年2月50例采用传统徒手植钉手术的患者作为对照组。两组患者性别、年龄、病程、主弯冠状面Cobb角、主弯Bending位Cobb角、主弯顶椎位置、椎弓根内径小于国人均值50%/75%椎体数量、顶椎旋转超过40°患者例数、单侧椎弓根缺失椎体数量等基线资料比较,差异均无统计学意义(P>0.05)。比较两组融合节段数量、植钉时间、植钉数量、植钉出血量、植钉透视次数、手动改道次数,观察植钉并发症发生情况;基于术后2周X线片,对植钉位置分级并计算植钉准确率,同时计算主弯矫正率。结果两组均顺利完成手术。其中,试验组植入267枚螺钉,融合177个椎体;对照组植入523枚螺钉,融合358个椎体。两组融合节段数量、植钉数量、植钉等级及准确率、主弯矫正率比较,差异均无统计学意义(P>0.05);但试验组植钉时间、植钉出血量、植钉透视次数以及手动改道次数均少于对照组(P<0.05)。两组术中及术后均未出现植钉相关并发症。结论新型导板适配各种畸形椎板关节突,用于脊柱侧弯矫形术中不仅提高了植钉准确性,还降低了手术操作难度、缩短手术时间、减少术中出血。

Objective To explore the effectiveness of a new point contact pedicle navigation template(referred to as“new navigation template”for simplicity)in assisting screw implantation in scoliosis correction surgery.Methods Twenty-five patients with scoliosis,who met the selection criteria between February 2020 and February 2023,were selected as the trial group.During the scoliosis correction surgery,the three-dimensional printed new navigation template was used to assist in screw implantation.Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group.There was no significant difference between the two groups(P>0.05)in terms of gender,age,disease duration,Cobb angle on the coronal plane of the main curve,Cobb angle at the Bending position of the main curve,the position of the apical vertebrae of the main curve,and the number of vertebrae with the pedicle diameter lower than 50%/75%of the national average,and the number of patients whose apical vertebrae rotation exceeded 40°.The number of fused vertebrae,the number of pedicle screws,the time of pedicle screw implantation,implant bleeding,fluoroscopy frequency,and manual diversion frequency were compared between the two groups.The occurrence of implant complications was observed.Based on the X-ray films at 2 weeks after operation,the pedicle screw grading was recorded,the accuracy of the implant and the main curvature correction rate were calculated.Results Both groups successfully completed the surgeries.Among them,the trial group implanted 267 screws and fused 177 vertebrae;the control group implanted 523 screws and fused 358 vertebrae.There was no significant difference between the two groups(P>0.05)in terms of the number of fused vertebrae,the number of pedicle screws,the pedicle screw grading and accuracy,and the main curvature correction rate.However,the time of pedicle screw implantation,implant bleeding,fluoroscopy frequency,and manual diversion frequency were significantly lower in trial group than in control group(P<0.05).There was no complications related to screws implantation during or after operation in the two groups.Conclusion The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process,which not only improves the accuracy of screw implantation,but also reduces the difficulty of operation,shortens the operation time,and reduces intraoperative bleeding.