CAJ | 학술논문

目的探讨二维计算机辅助手术导航对双侧腰椎椎弓根螺钉置入一致性的影响.方法 2004年1月至2009年12月,接受腰椎后路椎弓根螺钉内固定术患者1355例,男696例,女659例.应用二维计算机辅助手术导航辅助置钉(导航组)743例,X线透视辅助置钉(透视辅助组)612例.应用Image-pro plus 5.0软件对术后第7天内的标准腰椎正侧位X线片进行图像测量分析,比较两组L1～S1双侧椎弓根螺钉置入的一致性.在腰椎侧位X线片上测量双侧椎弓根螺钉轴线与所在椎体上终板的夹角(α角),双侧椎弓根螺钉轴线的夹角(γ角);在腰椎正位X线片上判定椎弓根螺钉是否在椎弓根内,计算椎弓根螺钉全在椎弓根内的准确率.结果导航组左侧α角平均3.89°±0.47°、右侧α角平均3.94°±0.37°,L1～S1各节段双侧α角的差异均无统计学意义;透视辅助组左侧α角平均4.32°±1.47°、右侧α角平均4.37°±1.59°,其中L2(左侧4.55°±1.27°,右侧5.12°±1.87°)和L4(左侧4.22°±1.89°,右侧6.62°±1.97°)节段双侧α角的差异有统计学意义,其他节段双侧α角的差异均无统计学意义.导航组γ角(2.32°±0.27°)小于透视辅助组(3.32°±1.51°),差异有统计学意义.导航组置钉准确率91.5％(3604/3938),透视辅助组87.6％(2426/2768),差异有统计学意义.结论二维计算机辅助手术导航椎弓根螺钉置钉的准确性高于X线透视辅助置钉,能提高双侧腰椎椎弓根螺钉置入的一致性.
목적 탐토이유계산궤보조수술도항대쌍측요추추궁근라정치입일치성적영향.방법 2004년1월지2009년12월,접수요추후로추궁근라정내고정술환자1355례,남696례,녀659례.응용이유계산궤보조수술도항보조치정(도항조)743례,X선투시보조치정(투시보조조)612례.응용Image-pro plus 5.0연건대술후제7천내적표준요추정측위X선편진행도상측량분석,비교량조L1～S1쌍측추궁근라정치입적일치성.재요추측위X선편상측량쌍측추궁근라정축선여소재추체상종판적협각(α각),쌍측추궁근라정축선적협각(γ각);재요추정위X선편상판정추궁근라정시부재추궁근내,계산추궁근라정전재추궁근내적준학솔.결과 도항조좌측α각평균3.89°±0.47°、우측α각평균3.94°±0.37°,L1～S1각절단쌍측α각적차이균무통계학의의;투시보조조좌측α각평균4.32°±1.47°、우측α각평균4.37°±1.59°,기중L2(좌측4.55°±1.27°,우측5.12°±1.87°)화L4(좌측4.22°±1.89°,우측6.62°±1.97°)절단쌍측α각적차이유통계학의의,기타절단쌍측α각적차이균무통계학의의.도항조γ각(2.32°±0.27°)소우투시보조조(3.32°±1.51°),차이유통계학의의.도항조치정준학솔91.5％(3604/3938),투시보조조87.6％(2426/2768),차이유통계학의의.결론 이유계산궤보조수술도항추궁근라정치정적준학성고우X선투시보조치정,능제고쌍측요추추궁근라정치입적일치성.
Objective To investigate the influence of the two-dimension computer-aided surgery navigation system to the concordance of lumbar spine pedicle screw fixation on both sides.Methods 1355 patients were undergone lumbar spinal pedicle screw fixation during January 2004 to December 2009.All patients were divided into tow groups:the navigation group (743cases) and the fluoroscopy assistant group (612 cases).All patients got standard A-P and lateral X-ray plate of lumbar spine within seven days after surgery.The X-ray images were analyzed by the software of Image-pro plus 5.0 to evaluate the concordance of lumbar spine pedicle screw fixation on both sides.The angle between axial line of pedicle screw and superior lamina terminals (α angle) and the angle between axial lines of pedicle screw on both sides (γangle) were measured.The position of the pedicle screw was checked weather it was in the lumbar pedicle partially.Results There were no significant differences (P＞0.05) between the α angle on both sides of L1-S5 vertebral body in navigation assistant group (L:3.89°±0.47°,R:3.94°±0.37°).The differences of the α angle on both sides of L2 (L:4.55°±1.27°,R:5.12°±1.87°) and L4 (L:4.22°±1.89°,R:6.62°±1.97°) vertebral body in the fluoroscopy assistant group had statistical significance (P＜0.05).There were no significant differences between the α angle on both sides of other bodies (L:4.32°±1.47°,R:4.37°±1.59°,P＞0.05).The γangle in navigation assistant group (2.32°± 0.27°) was obviously smaller than fluoroscopy assistant group (3.32°±1.51°),the differences had statistical significance (P＜0.05).Accuracy of pedicle screw in navigation assistant group was 91.5％ (3604/3938).Accuracy of pedicle screw in fluoroscopy assistant group was 87.6％ (2426/2768).The difference in accuracy of pedicle screw in both groups had statistical significance (x2=26.913,P＜0.0001).Conclusion The accuracy of pedicle screw and the concordance of pedicle screw on both sides can be significantly improved using the two-dimension perspective computer-aided surgery navigation system.