CT三维重建及薄层扫描在特发性脊柱侧弯矫正手术中的应用

Application of CT 3D Reconstruction and Thin-Slice Scanning in Idiopathic Scoliosis Correction Surgery

目的:探讨CT三维重建及薄层扫描在特发性脊柱侧弯矫正手术中的应用。方法:本研究为回顾性研究,选取2020年6月至2023年6月在本院收治的112例行择期矫正术的特发性脊柱侧弯患者作为本研究观察对象,根据手术方式分为徒手置钉组(n=42),接受常规解剖标志法结合C型臂透视定位指导,和CT三维辅导组(n=70),接受CT三维重建配合薄层扫描指导。对比两组置钉准确率、术中透视次数、出血量、手术时间和术后住院时间;记录并比较两组患者手术前后视觉疼痛目测类比评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分和cobb角变化;观察两组并发症。结果:CT三维辅导组共置入1192枚螺钉,徒手置钉组共置入673枚螺钉。其中CT三维辅导组置钉准确率达95.71%(1141/1192),高于徒手置钉组的91.08%(613/673)(P<0.05)。CT三维辅导组术中透视次数少于徒手置钉组,术中出血量低于徒手置钉组,手术时间短于徒手置钉组(P<0.05)。两组术后住院时间比较差异无统计学意义(P>0.05)。较术前比较,两组术后VAS均下降、JOA评分均上升,主弯cobb角均降低(P<0.05),且CT三维辅导组JOA上升程度和主弯cobb角下降程度均高于徒手置钉组(P<0.05),两组VAS改善程度比较差异无统计学意义(P>0.05)。两组患者均未发生严重并发症,仅有1例患者出现切口愈合不良。结论:CT三维重建及薄层扫描可有效指导特发性脊柱侧弯术,提高手术质量,减少术中X线暴露,缩短手术时间,降低出血量,促进术后恢复。

Objective:To investigate the application of CT 3D reconstruction and thin-slice scanning in idiopathic scoliosis correction surgery.Methods:This retrospective study included 112 patients with idiopathic scoliosis who underwent elective correction surgery at our institution between June 2020 and June 2023.Patients were divided into two groups based on surgical approach:the freehand pedicle screw placement group(n=42),who received conventional anatomical landmark guidance with C-arm fluoroscopy,and the CT 3D guidance group(n=70),who received CT 3D reconstruction guidance combined with thin-slice scanning.The two groups were compared in terms of pedicle screw accuracy,intraoperative fluoroscopy count,blood loss,surgical time,and postoperative length of hospital stay.The visual analogue scale(VAS)for pain,Japanese Orthopaedic Association(JOA)score,and Cobb angle changes were recorded and compared pre-and postoperatively for both groups.Complications were also observed.Results:A total of 1192 pedicle screws were inserted in the CT 3D guidance group and 673 pedicle screws were inserted in the freehand pedicle screw placement group.The pedicle screw accuracy rate in the CT 3D guidance group was 95.71%(1141/1192),which was significantly higher than that in the freehand pedicle screw placement group[91.08%(613/673);P<0.05].The CT 3D guidance group had fewer intraoperative fluoroscopies,less blood loss,and shorter surgical time compared to the freehand pedicle screw placement group(P<0.05).There was no significant difference in postoperative length of hospital stay between the two groups(P>0.05).Compared to preoperative values,both groups showed a decrease in VAS scores,an increase in JOA scores,and a decrease in main Cobb angles postoperatively(P<0.05).The CT 3D guidance group had a greater improvement in JOA scores and a greater reduction in main Cobb angles compared to the freehand pedicle screw placement group(P<0.05),while there was no significant difference in VAS score improvement between the two groups(P>0.05).No serious complications occurred in either group,and only one patient developed wound healing complications.Conclusion:CT 3D reconstruction and thin-slice scanning can effectively guide idiopathic scoliosis surgery,improving surgical quality,reducing intraoperative X-ray exposure,shortening surgical time,decreasing blood loss,and promoting postoperative recovery.