脊柱侧弯矫正术中三维导航椎弓根钉置入的意义

Intraoperative three-dimensional navigation used in pedicle screw placement for correction of scoliosis

[目的]探究术中导航系统在脊柱侧弯矫形手术置钉中的临床应用效果。[方法]回顾性分析本院2015年7月—2018年7月手术治疗的脊柱侧弯40例患者的临床资料,依据术前医患沟通结果,21例采用术中三维即时导航系统辅助置钉(导航组),19例采用传统徒手方法置钉(徒手组)。比较两组围手术期、随访及影像资料。[结果]所有患者均顺利手术,无严重术中并发症。导航组置钉准确度[A/B/C/D/E,(221/8/5/0/0) vs (174/19/12/7/0), P<0.001]、手术时间[(43.7±12.2) min vs (65.4±19.7) min, P<0.001]、术中出血量[(623.2±40.5) ml vs (1 024.3±38.3) ml, P<0.001]、单钉置入时间[(2.2±1.3) min vs (5.1±2.4) min, P<0.001]均显著优于徒手组,但两组间下地行走时间、住院时间差异无统计学意义(P>0.05)。40例患者随访12~24个月,平均(18.2±4.6)个月,随时间推移,两组患者VAS评分及ODI均显著下降(P<0.05)。相应时间点,两组间VAS及ODI评分的差异均无统计学意义(P>0.05);两组患者均未出现后期畸形加重,均无翻修手术等并发症。影像方面,与术前相比,术后2周及末次随访两组的主弯Cobb角、后凸Cobb角、C7PL-CSVL及SVA均显著改善(P<0.05);相应时间点,两组间上述影像测量指标比较均无明显差异(P>0.05)。[结论]术中即时三维导航系统的应用使脊柱侧弯矫正手术置钉更加准确、快速,降低了手术风险,临床效果显著。

[Objective]To explore the clinical efficiency of the intraoperative navigation system used in pedicle screw placement for correction of scoliosis.[Methods]A retrospective study was conducted on 40 patients who underwent surgical correction with pedicle screw-rod system for scoliosis in our hospital from July 2015 to July 2018.According to the preoperative doctor-patient communication,21 patients had the pedicle screws placed assisted by intraoperative three-dimensional real-time navigation system(the navigation group),while the remaining 19 patients had screws placed by the traditional freehand technique(the freehand group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had corresponding surgical procedures performed smoothly without serious complications.The navigation group proved significantly superior to the freehand group in terms of accuracy of screw placement[A/B/C/D/E,(221/8/5/0/0)vs(174/19/12/7/0),P<0.001],operation time[(43.7±12.2)min vs(65.4±19.7)min,P<0.001],in⁃traoperative blood loss[(623.2±40.5)ml vs(1024.3±38.3)ml,P<0.001],a single screw insertion time[(2.2±1.3)min vs(5.1±2.4)min,P<0.001],but there was no significant difference in walking time and hospital stay between the two groups(P>0.05).As time went during fol⁃low-up period lasted for 12~24 months,with an average of(18.2±4.6)months,both VAS and ODI scores in both groups significantly de⁃creased(P<0.05).At any corresponding time points,there were no significant differences in VAS and ODI scores between the two groups(P>0.05).There was no complications,such as later deformity aggravation and revision surgery in any patients in both groups.Regarding im⁃aging,the Cobb angle of main curvature,kyphotic Cobb angle,C7PL-CSVL and SVA significantly improved in both groups 2 weeks after surgery and at the last follow-up compared with those preoperatively(P<0.05),which were not statistically significant between the two groups at any time points accordingly(P>0.05).[Conclusion]Application of the intraoperative real-time 3D navigation system makes pedi⁃cle screw placement for correction of scoliosis more accurate and rapid,reduces the risk of surgery,and achieve significantly improved clini⁃cal efficiency.