导航引导椎弓钉加椎间钛笼稳定腰椎椎节的手术应用

Using computer-assisted fluoroscopic navigation to guide pedicle screws and cages in lumbar segmental instability surgery

目的 :探讨导航技术在腰椎内植物手术中的应用。方法 :对 2 0例下腰椎节失稳手术 ,采用导航下的椎弓钉加后路椎间钛笼植入技术。共 49个椎节 ,98枚椎弓钉 ,5 8个钛笼。内植完成后即作X线正侧位摄片与导航路径进行吻合测量 ;术后作CT椎弓根层面扫描。结果 :内植物位置理想 ,进钉点均差 2 2mm (最大 3mm) ,角度均差 3°(最大 5°) ;Cage深度均差 1 8mm (最大 3 2mm) ,轴线角度均差 2° (最大 4°)。CT椎弓钉位置评级 :理想 94枚( 96% ) ,4枚突破椎弓根外侧皮质 ( 4% ) ,Ⅱ级 3枚 ,Ⅲ级 1枚。结论 :导航引导椎弓钉、椎间钛笼植入 ,只需 1次X线成像就能做出虚拟的手术环境和路径 ;导航的瞬时追踪功能 ,使术者的手术工具做到实时监测 ,内植物达到精确制导 ,使操作形象、多维化 ,实时感强 ,是一种理想内植物引导模式。

Objective:To introduce a new way by using fluoronav Tech guiding the implants in lumbar stability surgery Method:For 20 cases with lumbar segmental instability,using computer assisted fluoroscopic navigation technology as guidance to implant 98 pedicle screws and 58 cages in 49 segments Postimplantatively,to measure the implants' images error between virtual and live fluoroscopy All screws were evaluated by use of a standardized grading scheme through thin cut CT scans postoperatively Result:Excellent correlation was observed For screws,mean entry point error was 2 2mm (max 3mm),mean trajectory angle difference was 3° (max 5°);of 98 screws reviewed by CT scan,there were 4 cortical violations,but laterally,3 were grade Ⅱ (≤2mm),1 was grade Ⅲ (≥2mm) For cages,mean depth error was 1 8mm (max 3 2mm),mean axis angle difference was 2° (max 4°) Conclusion:Fluoronav Tech offers several advantages over conventional fluoroscopy while providing acceptable targeting accuracy It enables a single C arm to provide real time,multiplanar procedural guidance It also reduces radiation exposure to the patient and surgical team It will be an ideal guided method for spinal surgery