CT三维重建联合仿真钉道建立在腰椎骨折治疗中的应用价值

Application Value of 3D-CT Reconstruction Combined with Establishment of Simulated Screw Path in the Treatment of Lumbar Fracture

目的探讨CT三维重建联合仿真钉道建立在腰椎骨折治疗中的应用价值。方法选取2019年1月—2023年1月收治行椎弓根螺钉内固定术的126例腰椎骨折,采用随机数字表法分为观察组63例和对照组63例,观察组接受CT三维重建联合仿真钉道建立指导手术,对照组接受常规解剖标志法结合C型臂X线透视定位指导手术。观察并比较2组置钉优良率、置钉时间、置钉出血量,手术前后评估患者腰椎Oswestry功能障碍指数(ODI)评分、下腰痛日本骨科协会评分(JOA)、下肢Fugl-Meyer运动功能评定量表(FMA)评分和腰椎功能恢复情况,并观察术后并发症。结果观察组置钉优良率为94.67%(302/319)高于对照组的88.79%(285/321)(P<0.01);观察组置钉时间短于对照组,置钉出血量少于对照组(P<0.01)。术后6个月,观察组ODI、JOA评分低于对照组,FMA评分高于对照组(P<0.05,P<0.01)。观察组术后总并发症发生率低于对照组(P<0.05)。结论利用CT三维重建联合仿真钉道的建立来指导手术,可有效提高腰椎骨折行椎弓根内固定术患者置钉优良率,缩短置钉时间,减少出血量,降低术后并发症发生风险,促进患者术后腰椎功能恢复。

Objective To investigate the application value of 3D-CT reconstruction combined with the establishment of simulated screw path in the treatment of lumbar fractures.Methods A total of 126 patients with lumbar fracture who underwent pedicle screw internal fixation from January 2019 to January 2023 were selected and randomly divided into the observation group(n=63)and the control group(n=63)according to random number table method.The observation group received 3D-CT reconstruction combined with simulated screw path establishment guidance surgery,and the control group received conventional anatomic marker combined with C-arm X-ray positioning guidance surgery.The excellent and good rate,time and blood loss of pedicle screw fixation in the two groups were observed and compared.The scores of Oswestry Disability Index(ODI),Japanese Orthopaedic Association(JOA)score,Fugl-Meyer Motor Function Assessment Scale(FMA)before and after surger,and postoperative lumbar function recovery were evaluated,and postoperative complications were observed.Results The excellent and good rate of pedicle screw fixation in observation group was 94.67%(302/319),which was higher than that in control group[88.79%(285/321)](P<0.01).The time of pedicle screw fixation in the observation group was shorter than that in the control group,and the blood loss of pedicle screw fixation was less than that in the control group(P<0.01).At 6 months after operation,ODI and JOA scores in observation group were lower than those in control group,while FMA scores were higher than those in control group(P<0.05,P<0.01).The incidence of postoperative complications in observation group was lower than that in control group(P<0.05).Conclusion The use of 3D-CT reconstruction combined with the establishment of simulated screw path to guide the operation can effectively improve the excellent and good rate of pedicle internal fixation in patients with lumbar fracture,shorten the time of pedicle screw fixation,reduce the amount of blood loss,reduce the risk of postoperative complications,and promote the recovery of lumbar function.