O形臂联合CT三维导航系统辅助置钉与徒手置钉治疗下颈椎骨折脱位的疗效比较

Efficacy of O‑arm combined with CT three‑dimensional navigation system assisted versus manual screw placement in the treatment of lower cervical fracture and dislocation

目的比较O形臂联合CT三维导航系统辅助置钉与徒手置钉治疗下颈椎骨折脱位的临床效果。方法采用回顾性队列研究分析2021年5月至2022年2月西安交通大学附属红会医院收治的41例下颈椎骨折脱位患者的临床资料,其中男26例,女15例;年龄31.5~48.6岁[(41.5±15.0)岁]。损伤节段:C_(3)3例,C_(4)12例,C_(5)13例,C610例,C_(7)3例。19例采用O形臂联合CT三维导航系统置入颈椎椎弓根螺钉(导航组,76枚螺钉),22例采用徒手置入颈椎椎弓根螺钉(传统组,88枚螺钉)。比较两组总手术时间、有效手术时间、单钉置入时间、单钉修正次数、螺钉距前方皮质距离、术中出血量、术中透视辐射剂量、切口长度、住院时间;术前及术后3 d椎间隙高度、Cobb角、椎体间滑移距离、美国脊柱损伤协会(ASIA)分级;术前、术后3 d、术后3个月及末次随访时视觉模拟评分(VAS)、日本骨科学会(JOA)评分、颈部功能障碍指数(NDI);螺钉置入准确率及并发症发生率(邻近小关节侵犯、感染、螺钉松动)。结果患者均获随访11.1~13.9个月[(12.5±1.4)个月]。术中导航组总手术时间、术中出血量、术中透视辐射剂量、切口长度多于或大于传统组(P均<0.05)。导航组有效手术时间、单钉置入时间、单钉修正次数、螺钉距前方皮质距离少于或小于传统组(P均<0.05)。两组住院时间差异无统计学意义(P均>0.05)。两组内术后3 d椎间隙高度、Cobb角、椎体间滑移距离较术前改善(P均<0.05)。两组间术前及术后3 d椎间隙高度、Cobb角、椎体间滑移距离、ASIA分级比较,差异无统计学意义(P均>0.05)。两组内术后3 d、术后3个月及末次随访时VAS、JOA评分、NDI较术前改善(P均<0.05),且均随时间进一步改善。两组间术前及术后3个月VAS比较,差异无统计学意义(P均>0.05),但术后3 d及末次随访时导航组低于传统组(P均<0.05)。两组间术前、术后3 d及术后3个月JOA评分和NDI比较,差异无统计学意义(P均>0.05),但末次随访时导航组优于传统组(P均<0.05)。导航组置入0级、0+1级螺钉置入准确率分别为92.0%(70/76)、96.6%(73/76),高于传统组的88.7%(78/88)、93.5%(82/88)(P均<0.05)。导航组邻近小关节侵犯率A~C级分别为71.2%(54/76)、28.8%(22/76)、0%(0/76),传统组分别为60.5%(53/88)、32.3%(28/88)、7.3%(7/88)(P<0.05)。导航组无螺钉松动,传统组螺钉松动率为9.1%(8/88)(P<0.01)。结论与徒手置钉比较,O形臂联合CT三维导航系统辅助置钉治疗下颈椎骨折脱位,具有有效手术时间短、螺钉置入快、螺钉把持力强、颈椎稳定性好、术后疼痛轻、置钉准确率高、小关节侵犯率和螺钉松动率低等优点。

Objective To compare the clinical efficacies of O‑arm combined with CT three‑dimensional navigation system assisted screw placement versus manual screw placement in treating lower cervical fracture and dislocation.Methods A retrospective cohort study was used to analyze the clinical data of 41 patients with lower cervical fracture and dislocation,who were treated in Honghui Hospital,Xi′an Jiaotong University from May 2021 to February 2022.The patients included 26 males and 15 females,aged 31.5-48.6 years[(41.5±15.0)years].The injured segments were C_(3)in 3 patients,C_(4)in 12,C_(5)in 13,C_(6)in 10 and C_(7)in 3.Nineteen patients were treated with cervical pedicle screws by O‑shaped arm combined with CT three‑dimensional navigation system(navigation group,76 screws)and 22 by bare hands(traditional group,88 screws).The total operation time,effective operation time,single nail placement time,single screw correction times,screw distance from anterior cortex,intraoperative blood loss,intraoperative fluoroscopic radiation dose,incision length and length of hospital stay were compared between the two groups,and the height of intervertebral space,Cobb angle,interbody slip distance and American Spinal injury Association(ASIA)grade were compared before operation and at 3 days after operation.Visual analogue score(VAS),Japanese Orthopedic Association(JOA)score,and neck dysfunction index(NDI)were evaluated before operation,at 3 days,3 months after operation and at the last follow‑up.Accuracy of screw placement and incidence of complications(adjacent facet joint invasion,infection,screw loosening)were detected as well.Results All the patients were followed up for 11.1-13.9 months[(12.5±1.4)months].The total operation time,intraoperative blood loss,intraoperative fluoroscopic radiation dose and incision length in the navigation group were more or longer than those in the traditional group(all P<0.05).The effective operation time,single nail placement time,single nail correction times and screw distance from anterior cortex in the navigation group were markedly less or smaller than those in the traditional group(all P<0.05).There was no significant difference in the length of hospital stay between the two groups(P>0.05).There were significant improvements in the height of intervertebral space,Cobb angle and interbody slip distance between the two groups at 3 days after operation(all P<0.05).There was no significant difference in the height of intervertebral space,Cobb angle,interbody slip distance or ASIA grade between the two groups before operation or at 3 days after operation(all P>0.05).Compared with pre‑operation,the VAS,JOA score and NDI were significantly improved in both groups at 3 days,3 months after operation and at the last follow‑up(all P<0.05),with further improvement with time.There was no significant difference in VAS between the two groups before operation or at 3 months after operation(all P>0.05),but it was markedly lower in the navigation group compared with the traditional group at 3 days after operation and at the last follow‑up(all P<0.05).There were no significant differences in JOA score or NDI between the two groups before operation or at 3 days and 3 months after operation(all P>0.05),but both were lower in the navigation group compared with the traditional group at the last follow‑up(all P<0.05).The accuracies of placement of grade 0 and grade 0+1 screws were 92.0%(70/76)and 96.6%(73/76)in the navigation group,respectively,which were markedly higher than 88.7%(78/88)and 93.5%(82/88)in the traditional group(all P<0.05).The rates of adjacent facet joint invasion of A,B,and C degrees were 71.2%(54/76),28.8%(22/76)and 0%(0/76)in the navigation group,respectively,while the invasion rates were 60.5%(53/88),32.3%(28/88)and 7.3%(7/88)in the traditional group(P<0.05).No screw loosening was noted in the navigation group,but the screw loosening rate was 9.1%(8/88)in the traditional group(P<0.01).Conclusion Compared with manual screw placement,O‑arm combined with CT three‑dimensional navigation system assisted screw placement for lower cervical fracture and dislocation has the advantages of shorter effective operation time,quicker screw placement,stronger screw holding force,better cervical stability,slighter postoperative pain,higher screw placement accuracy,and lower facet joint invasion and screw loosening rates.