Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroy...Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed pedicles.Intraoperative three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration.The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological function.Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same.In the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was detected.Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine stability.The ITFN system provides a high accuracy of pedicle screw placement.展开更多
背景:下颈椎椎弓根钉因具有优良的生物力学优势而广泛用于创伤、肿瘤及畸形导致的多种颈椎疾病。如何提高置钉准确性,减少术后并发症,一直是下颈椎椎弓根钉技术研究的热点。目的:查阅国内外相关文献,综述近年国内外有关下颈椎椎弓根钉...背景:下颈椎椎弓根钉因具有优良的生物力学优势而广泛用于创伤、肿瘤及畸形导致的多种颈椎疾病。如何提高置钉准确性,减少术后并发症,一直是下颈椎椎弓根钉技术研究的热点。目的:查阅国内外相关文献,综述近年国内外有关下颈椎椎弓根钉技术的相关解剖形态学特点、下颈椎后路椎弓根钉生物力学特点及其置钉技术的研究,分析各置钉技术的优点与不足。方法:分别以"cervical,pedicle"及"颈椎,椎弓根"为检索词检索PubMed、Web of Science及CNKI、万方等数据库中的相关文献,中文检索2015年1月至2020年12月发表的相关文献,英文检索近5年发表的相关文献。最终纳入文献52篇,其中中文文献22篇,英文文献30篇。结果与结论:(1)对于椎弓根的皮质厚度与强度而言,内侧壁均高于外侧壁;从C3-C7椎弓根的外展角逐渐减小,而椎弓根的形态则类似于长圆形;椎弓根上缘距其上位神经根从C3-C7逐渐增大,椎弓根下缘距其下位神经根从C3-C7逐渐减小,而椎弓根前外侧壁紧贴椎动脉,椎弓根前内侧壁紧贴硬膜外窦;(2)椎弓根的上、下、外侧三侧壁的突破力均小于内侧壁;在抗拔出力方面,直接拔出力椎弓根钉优于椎间孔钉与侧块螺钉,疲劳拔出力椎弓根钉与椎间孔钉优于侧块螺钉;(3)目前下颈椎后路椎弓根钉置钉技术主要包括徒手置钉、计算机导航辅助置钉、3D打印导板辅助置钉、手术机器人辅助置钉等,但各种技术流派均有一定不足,今后一段时间内徒手置钉技术仍将是下颈椎椎弓根钉置钉技术的主流,随着技术水平的提升和配套人工智能辅助科技设备的完善,人工智能辅助置钉技术将是未来的发展方向。展开更多
目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研...目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研究为回顾性队列研究,回顾了2020年6月~2022年月6月于首都医科大学附属北京世纪坛医院行单节段减压融合且行机器人辅助下置钉的腰椎管狭窄症患者,共纳入99例,其中男性59例,女性40例,平均年龄67.07±4.65岁;应用皮质骨螺钉固定者41例(RCBTS组),应用椎弓根螺钉固定者58例(RPS组)。比较两种不同术式的切口长度、手术时间、术中出血量、术后的24h引流量、术后住院天数;比较术后3d、3个月、6个月的日本骨科协会(Japanese Orthopaedic Association,JOA)评分和腰痛视觉模拟评分(visual analogue scale,VAS),并对JOA评分和VAS评分变化进行了固定效应检验;通过审查术后影像学资料,根据Gertzbein-Robbins方法对螺钉位置进行分级,计算两种术式的置钉准确率;比较两种术式围术期以及术后3个月的并发症发生情况。结果:两组患者基线数据无统计学差异(P>0.05)。RCBTS组患者的手术时长(134.39±22.23min vs 152.93±19.10min,P<0.001)、切口长度(64.93±3.71mm vs 78.84±3.82mm,P<0.001)、术中出血(155.61±37.15mL vs 172.41±43.22mL,P=0.001)、术后24h引流量(83.66±21.54mL vs 101.21±29.80mL,P=0.002)以及术后住院天数(4.90±1.26d vs 6.26±1.66d,P<0.001)均显著小于RPS组患者。两组患者的JOA评分和VAS评分变化在各时间点无显著性差异(P>0.05)。固定效应检验结果表明时间是JOA和VAS评分变化的固定效应(P<0.001)。两组的各级别置钉率(A级:152/164 vs 211/232,P=0.538;B级:9/164 vs 15/232,P=0.688;C级:3/164 vs 6/232,P=0.619)、临床可接受率(161/164 vs 226/232,P=0.619)、置钉不良率(3/164 vs 6/232,P=0.619)以及术后并发症(仅RCBTS组一例患者出现伤口延迟愈合)的发生情况均无显著性差异(P>0.05)。结论:与RPS相比,接受RCBTS的患者在手术时间、切口长度、术中出血量、术后引流量以及术后住院时长方面均具有显著优势;在术后功能恢复和腰痛改善间两组没有显著差异。展开更多
文摘Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed pedicles.Intraoperative three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration.The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological function.Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same.In the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was detected.Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine stability.The ITFN system provides a high accuracy of pedicle screw placement.
文摘背景:下颈椎椎弓根钉因具有优良的生物力学优势而广泛用于创伤、肿瘤及畸形导致的多种颈椎疾病。如何提高置钉准确性,减少术后并发症,一直是下颈椎椎弓根钉技术研究的热点。目的:查阅国内外相关文献,综述近年国内外有关下颈椎椎弓根钉技术的相关解剖形态学特点、下颈椎后路椎弓根钉生物力学特点及其置钉技术的研究,分析各置钉技术的优点与不足。方法:分别以"cervical,pedicle"及"颈椎,椎弓根"为检索词检索PubMed、Web of Science及CNKI、万方等数据库中的相关文献,中文检索2015年1月至2020年12月发表的相关文献,英文检索近5年发表的相关文献。最终纳入文献52篇,其中中文文献22篇,英文文献30篇。结果与结论:(1)对于椎弓根的皮质厚度与强度而言,内侧壁均高于外侧壁;从C3-C7椎弓根的外展角逐渐减小,而椎弓根的形态则类似于长圆形;椎弓根上缘距其上位神经根从C3-C7逐渐增大,椎弓根下缘距其下位神经根从C3-C7逐渐减小,而椎弓根前外侧壁紧贴椎动脉,椎弓根前内侧壁紧贴硬膜外窦;(2)椎弓根的上、下、外侧三侧壁的突破力均小于内侧壁;在抗拔出力方面,直接拔出力椎弓根钉优于椎间孔钉与侧块螺钉,疲劳拔出力椎弓根钉与椎间孔钉优于侧块螺钉;(3)目前下颈椎后路椎弓根钉置钉技术主要包括徒手置钉、计算机导航辅助置钉、3D打印导板辅助置钉、手术机器人辅助置钉等,但各种技术流派均有一定不足,今后一段时间内徒手置钉技术仍将是下颈椎椎弓根钉置钉技术的主流,随着技术水平的提升和配套人工智能辅助科技设备的完善,人工智能辅助置钉技术将是未来的发展方向。
文摘目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研究为回顾性队列研究,回顾了2020年6月~2022年月6月于首都医科大学附属北京世纪坛医院行单节段减压融合且行机器人辅助下置钉的腰椎管狭窄症患者,共纳入99例,其中男性59例,女性40例,平均年龄67.07±4.65岁;应用皮质骨螺钉固定者41例(RCBTS组),应用椎弓根螺钉固定者58例(RPS组)。比较两种不同术式的切口长度、手术时间、术中出血量、术后的24h引流量、术后住院天数;比较术后3d、3个月、6个月的日本骨科协会(Japanese Orthopaedic Association,JOA)评分和腰痛视觉模拟评分(visual analogue scale,VAS),并对JOA评分和VAS评分变化进行了固定效应检验;通过审查术后影像学资料,根据Gertzbein-Robbins方法对螺钉位置进行分级,计算两种术式的置钉准确率;比较两种术式围术期以及术后3个月的并发症发生情况。结果:两组患者基线数据无统计学差异(P>0.05)。RCBTS组患者的手术时长(134.39±22.23min vs 152.93±19.10min,P<0.001)、切口长度(64.93±3.71mm vs 78.84±3.82mm,P<0.001)、术中出血(155.61±37.15mL vs 172.41±43.22mL,P=0.001)、术后24h引流量(83.66±21.54mL vs 101.21±29.80mL,P=0.002)以及术后住院天数(4.90±1.26d vs 6.26±1.66d,P<0.001)均显著小于RPS组患者。两组患者的JOA评分和VAS评分变化在各时间点无显著性差异(P>0.05)。固定效应检验结果表明时间是JOA和VAS评分变化的固定效应(P<0.001)。两组的各级别置钉率(A级:152/164 vs 211/232,P=0.538;B级:9/164 vs 15/232,P=0.688;C级:3/164 vs 6/232,P=0.619)、临床可接受率(161/164 vs 226/232,P=0.619)、置钉不良率(3/164 vs 6/232,P=0.619)以及术后并发症(仅RCBTS组一例患者出现伤口延迟愈合)的发生情况均无显著性差异(P>0.05)。结论:与RPS相比,接受RCBTS的患者在手术时间、切口长度、术中出血量、术后引流量以及术后住院时长方面均具有显著优势;在术后功能恢复和腰痛改善间两组没有显著差异。
