中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
11期
838-841
,共4页
田伟%郎昭%刘亚军%刘波%李勤%胡临%李志宇%袁强%何达%程晓光%孙玉珍
田偉%郎昭%劉亞軍%劉波%李勤%鬍臨%李誌宇%袁彊%何達%程曉光%孫玉珍
전위%랑소%류아군%류파%리근%호림%리지우%원강%하체%정효광%손옥진
腰椎%旋转%外科手术,计算机辅助%内固定
腰椎%鏇轉%外科手術,計算機輔助%內固定
요추%선전%외과수술,계산궤보조%내고정
Lumbar vertebrae%Rotation%Surgery,computer-assisted%Internal fixation
目的 探讨腰椎椎体轴性旋转时术中即时三维导航对提高椎弓根螺钉置入精确件的作用.方法 将不同轴性旋转角度(0°、5°、10°、20°)的16具相同腰椎仿真模型平均分为传统方法组与即时导航组(每一旋转角度4具),随机用传统方法及术中即时三维导航法置入椎弓根螺钉,术后采集CT图像,重建螺钉轴线正交平面的椎弓根断层影像并应用Photeshop软件提取椎弓根外侧皮质轮廓线,通过判断钉道与椎弓根皮质间相互关系以及测量椎弓根外侧皮质缘距离螺钉轴线最短距离评价螺钉置入精确性.结果 两组置入腰椎椎弓根螺钉各80枚.传统方法组中,不同椎体轴性旋转角度的置钉精确性差异有统计学意义(P＜0.05),随旋转角度增大,置钉精确性降低.即时导航组置钉精确性高于传统方法组(P＜0.01);轴性旋转20°时的定性评价及轴性旋转5°、10°和20°时的定量评价,两组置钉精确性差异均有统计学意义(P＜0.05).结论 腰椎椎体轴性旋转可降低椎弓根螺钉置入精确性.术中即时三维导航系统辅助可提高腰椎椎弓根螺钉置入精确性.
目的 探討腰椎椎體軸性鏇轉時術中即時三維導航對提高椎弓根螺釘置入精確件的作用.方法 將不同軸性鏇轉角度(0°、5°、10°、20°)的16具相同腰椎倣真模型平均分為傳統方法組與即時導航組(每一鏇轉角度4具),隨機用傳統方法及術中即時三維導航法置入椎弓根螺釘,術後採集CT圖像,重建螺釘軸線正交平麵的椎弓根斷層影像併應用Photeshop軟件提取椎弓根外側皮質輪廓線,通過判斷釘道與椎弓根皮質間相互關繫以及測量椎弓根外側皮質緣距離螺釘軸線最短距離評價螺釘置入精確性.結果 兩組置入腰椎椎弓根螺釘各80枚.傳統方法組中,不同椎體軸性鏇轉角度的置釘精確性差異有統計學意義(P＜0.05),隨鏇轉角度增大,置釘精確性降低.即時導航組置釘精確性高于傳統方法組(P＜0.01);軸性鏇轉20°時的定性評價及軸性鏇轉5°、10°和20°時的定量評價,兩組置釘精確性差異均有統計學意義(P＜0.05).結論 腰椎椎體軸性鏇轉可降低椎弓根螺釘置入精確性.術中即時三維導航繫統輔助可提高腰椎椎弓根螺釘置入精確性.
목적 탐토요추추체축성선전시술중즉시삼유도항대제고추궁근라정치입정학건적작용.방법 장불동축성선전각도(0°、5°、10°、20°)적16구상동요추방진모형평균분위전통방법조여즉시도항조(매일선전각도4구),수궤용전통방법급술중즉시삼유도항법치입추궁근라정,술후채집CT도상,중건라정축선정교평면적추궁근단층영상병응용Photeshop연건제취추궁근외측피질륜곽선,통과판단정도여추궁근피질간상호관계이급측량추궁근외측피질연거리라정축선최단거리평개라정치입정학성.결과 량조치입요추추궁근라정각80매.전통방법조중,불동추체축성선전각도적치정정학성차이유통계학의의(P＜0.05),수선전각도증대,치정정학성강저.즉시도항조치정정학성고우전통방법조(P＜0.01);축성선전20°시적정성평개급축성선전5°、10°화20°시적정량평개,량조치정정학성차이균유통계학의의(P＜0.05).결론 요추추체축성선전가강저추궁근라정치입정학성.술중즉시삼유도항계통보조가제고요추추궁근라정치입정학성.
Objective To evaluate the effect of axial rotation of lumbar vertebrae on the accuracy of pedicle screw placement using the traditional method.as well as to assess the value of intraoperative three-dimensional(3D)navigation in improving the accuracy.Methods Sixteen lumbar simulation models at different degrees of axial rotation(0°,5°,10°and 20°),with every four assigned with the same degree,were equally divided into two groups(traditional method group and intraoperative 3D navigation group).Random placement of pedicle screws was carried out.followed by CT scan postoperatively.Then the outer pedicle cortex contours were depicted from reconstructed sectional pedicle images using Photoshop.The accuracy of pedicle screw placement was evaluated by determining the interrelationship between screw trajectory and pedicle cortex(qualitative)and measuring the shortest distance from pedicle screw axis to outer cortex of the pedicle(quantitative).Results Eighty pedicle screws were implanted respectively in each group.In traditional method group,statistical difference existed in the accuracy of pedicle screw placement at different axial rotational degrees(P＜0.05). With degrees increasing,the accuracy declined.The accuracy of intraoperative 3 D navigation group was higher than traditional method group in vertebrae with axial rotation(P＜0.01).In qualitative evaluation,the accuracy of the two methods had statistical difference when the degree was 20°,and in quantitative evaluation,statistical difference existed in 5°,10°and 20°of vertebral axisl rotation.Conciusions Screw malposition can be caused by vertebral axial rotation in lumbar spine using traditional method.Accuracy of pedicle screw placement declines with the increase of axial rotational degrees.However,the accuracy can be improved by using intraoperative 3D navigation.
