CAJ | 학술논문

目的探讨新型腰椎微创定位方法在定位时间、次数及放射暴露剂量方面的优势.方法 2010年5月至2013年2月收治腰椎间盘突出症合并腰椎不稳及胸腰椎骨折121例,随机分为两组:68例采用传统定位方法植入经皮椎弓根螺钉,单节段病变41例、双节段病变27例；53例采用自行研制的腰椎微创定位系统,单节段病变34例、双节段病变19例.两组患者性别、年龄、病程、手术节段的差异无统计学意义.结果传统定位方法组、微创定位方法组术前定位时间分别为(8.26±3.44) min、(3.51±1.82) min,平均定位次数分别为3.57次、1.22次,准确率分别为60.8％及96.2％.两组单节段病变患者植入双枚经皮椎弓根螺钉,术中定位时间分别为(15.12±4.69) min、(5.51±1.32) min,定位次数分别为6.47次、2.45次；双节段病变患者植入三枚经皮椎弓根螺钉,术中定位时间分别为(24.91±7.43) min、(8.84±2.32) min,定位次数分别为11.72次、3.69次.传统定位方法组手术人员颈部、胸部及手腕部检测出的放射暴露剂量分别为(3.09±0.24) Gy、(4.23±0.71) Gy、(5.17±0.62) Gy,微创定位方法组分别为(1.38±0.47) Gy、(2.69±0.33) Gy、(3.21±1.05) Gy.两组定位时间、定位次数及放射暴露剂量的差异有统计学意义.结论腰椎微创定位系统及定位方法能够简化手术操作,具有定位准确性高、定位时间短、透视次数少、医护人员及患者接受X线射线暴露量低的优点.
목적 탐토신형요추미창정위방법재정위시간、차수급방사폭로제량방면적우세.방법 2010년5월지2013년2월수치요추간반돌출증합병요추불은급흉요추골절121례,수궤분위량조:68례채용전통정위방법식입경피추궁근라정,단절단병변41례、쌍절단병변27례；53례채용자행연제적요추미창정위계통,단절단병변34례、쌍절단병변19례.량조환자성별、년령、병정、수술절단적차이무통계학의의.결과 전통정위방법조、미창정위방법조술전정위시간분별위(8.26±3.44) min、(3.51±1.82) min,평균정위차수분별위3.57차、1.22차,준학솔분별위60.8％급96.2％.량조단절단병변환자식입쌍매경피추궁근라정,술중정위시간분별위(15.12±4.69) min、(5.51±1.32) min,정위차수분별위6.47차、2.45차；쌍절단병변환자식입삼매경피추궁근라정,술중정위시간분별위(24.91±7.43) min、(8.84±2.32) min,정위차수분별위11.72차、3.69차.전통정위방법조수술인원경부、흉부급수완부검측출적방사폭로제량분별위(3.09±0.24) Gy、(4.23±0.71) Gy、(5.17±0.62) Gy,미창정위방법조분별위(1.38±0.47) Gy、(2.69±0.33) Gy、(3.21±1.05) Gy.량조정위시간、정위차수급방사폭로제량적차이유통계학의의.결론 요추미창정위계통급정위방법능구간화수술조작,구유정위준학성고、정위시간단、투시차수소、의호인원급환자접수X선사선폭로량저적우점.
Objective To introduce a new minimally invasive lumbar positioning system and its positioning method as well as conduct a prospective control study on the differences in positioning time,positioning frequency and radiation exposure dose between the new positioning method and the traditional positioning method.Methods 121 patients with lumbar disc herniation combined with lumbar instability and patients with thoracolumbar vertebral fracture admitted in our hospital from May 2010 to February 2013 were randomized into two groups.68 patients in Group A had undergone the traditional positioning method before and during operation.Among the 68 patients,41 were with single-segment lesion and 27 were with two-segment lesion.53 patients in Group B had undergone the new minimally invasive lumbar positioning system before and during operation.Among the 53 patients,34 were with single-segment lesion and 19 were with two-segment lesion.There were no significant differences in gender,age,course of disease and other general information between the two groups.The positioning time,positioning frequency and radiation dose of the two groups before and during operation were compared and statistically analyzed.Results The positioning time of Group A and Group B were 8.26±3.44 min and 3.51±1.82 min respectively; the positioning frequencies were 3.57 and 1.22; the accuracy were 60.8％ and 96.2％.For the patients with single-segment lesion,the positioning time before implanting two percutaneous pedicle screws during operation were 15.12±4.69 min and 5.51±1.32 min respectively and the positioning frequency were 6.47 and 2.45.For the patients with two-segment lesion,the positioning time before implanting three percutaneous pedicle screws during operation were 24.91±7.43 min and 8.84±2.32 min respectively and the positioning frequency were 11.72 and 3.69.Moreover,the radiation dose detected at neck,chest and wrist of the surgical staff in Group A were 3.09±0.24 Gy,4.23±0.71 Gy and 5.17±0.62 Gy and that detected in Group B were 1.38±0.47 Gy,2.69±0.33 Gy and 3.21±1.05 Gy.There were significant differences in positioning time,positioning frequency and radiation dose between Group A and Group B.Conclusion The minimally invasive spine positioning system and positioning method can simplify the operative procedures and largely reduce radiation exposure,which is characterized by high positioning accuracy,short positioning time,low fluoroscopy frequency and X-ray radiation dose.