导航系统对伴骨质疏松的椎体轴性旋转脊柱疾病患者椎弓根螺钉置入效果的影响

Influence of navigation system on efficacy of pedicle screw placement in spinal diseases with vertebral axial rotation and osteoporosis

目的观察导航系统对伴骨质疏松的椎体轴性旋转脊柱疾病患者椎弓根螺钉置入效果的影响。方法椎体轴性旋转脊柱疾病患者130例,其中伴发骨质疏松69例、非骨质疏松61例;均行椎弓根螺钉内固定治疗,在术中即时三维导航系统辅助下或X线透视(非导航)辅助下置入椎弓根螺钉。结果共置入1 091枚椎弓根螺钉内固定,其中导航辅助下置钉701枚,非导航辅助下置钉390枚。在骨质疏松患者中,导航下椎弓根螺钉置入位置满意度高于非导航(P<0.05);非导航下骨质疏松患者椎弓根螺钉置入位置满意度低于非骨质疏松患者(P<0.05)。椎体旋转0、Ⅱ度的骨质疏松患者导航下椎弓根螺钉置入位置满意度均高于非导航(P均<0.05)。结论术中即时三维导航系统可提高伴骨质疏松的椎体轴性旋转脊柱疾病患者椎弓根螺钉置入位置满意率,此作用在椎体旋转Ⅱ度患者中尤为明显。

Objective To investigate the influence of three-dimensional navigation system on efficacy of pedicle screw placement in patients with spinal diseases complicated with vertebral axial rotation and osteoporosis. Methods In this study,130 patients( 69 cases with osteoporosis and 61 cases without osteoporosis) were diagnosed spinal diseases complicated with vertebral axial rotation. They all received the treatment of pedicle screw fixation with three-dimensional navigation system or X-Ray fluoroscopy. Results A total of 1 091 pedicle screws( 701 screws with three-dimensional navigation system,390 screws with X-Ray fluoroscopy) were implanted. In the patients with osteoporosis,navigation group had higher satisfaction rate,and the difference had statistical significance( P < 0. 05). For groups without the use of navigation system,osteoporosis group had lower rate of satisfactory screw position and the difference had statistical significance( P <0. 05). In addition,navigation group got higher satisfaction rate in Nash-Moe Grade 0 and Grade Ⅱ,and the differences had statistical significance( all P < 0. 05). Conclusion The use of navigation system can exactly improve the rate of pedicle screw position satisfaction of patients with spinal diseases complicated with vertebral axial rotation and osteoporosis,especially in the Nash-Moe type Ⅱ degree and above.