CAJ | 학술논문

背景：脊柱后路椎弓根螺钉置入内固定是治疗脊柱各种病变及稳定脊柱的重要手段，计算机导航技术可以完整、直观、真实地再现各种组织形态及其相对位置，使术者实时获得三维图像信息，最大限度地避开手术危险区，直接引导内固定螺钉准确置入椎体。目的：评估计算机导航技术辅助脊柱后路椎弓根螺钉置入的准确性及安全性。方法：选择2008年7月至2014年1月在广西医科大学第一附属医院治疗的307例脊柱病变患者在计算机导航辅助下行脊柱后路椎弓根钉置入及椎板切除减压。术中行C臂透视检查螺钉位置的精确性，记录每枚螺钉的平均置钉时间、射线暴露时间，术后3 d复查X射线和置钉节段的三维CT，根据Andrew椎弓根螺钉CT位置分级标准对置钉位置进行评估。结果与结论：共置入螺钉1820枚，1778枚为Ⅰ级螺钉(准确率97.69%)。其中颈椎置入螺钉92枚，Ⅰ级螺钉90枚(准确率97.82%)，胸椎置入螺钉502枚，Ⅰ级螺钉492枚，准确率98%，腰椎置入螺钉1226枚,Ⅰ级螺钉1196，准确率97.2%。每枚螺钉的平均置钉时间(7.0±1.5) min。215例获随访，随访时间(12±6)个月，无内固定物移位、断裂等并发症以及神经血管损伤发生。提示计算机导航技术辅助脊柱椎弓根钉置入，能立体、多视角实时显示骨性解剖结构，保证了脊柱椎弓根钉置入的准确性及安全性，明显减少放射线的暴露强度。
배경：척주후로추궁근라정치입내고정시치료척주각충병변급은정척주적중요수단，계산궤도항기술가이완정、직관、진실지재현각충조직형태급기상대위치，사술자실시획득삼유도상신식，최대한도지피개수술위험구，직접인도내고정라정준학치입추체。목적：평고계산궤도항기술보조척주후로추궁근라정치입적준학성급안전성。방법：선택2008년7월지2014년1월재엄서의과대학제일부속의원치료적307례척주병변환자재계산궤도항보조하행척주후로추궁근정치입급추판절제감압。술중행C비투시검사라정위치적정학성，기록매매라정적평균치정시간、사선폭로시간，술후3 d복사X사선화치정절단적삼유CT，근거Andrew추궁근라정CT위치분급표준대치정위치진행평고。결과여결론：공치입라정1820매，1778매위Ⅰ급라정(준학솔97.69%)。기중경추치입라정92매，Ⅰ급라정90매(준학솔97.82%)，흉추치입라정502매，Ⅰ급라정492매，준학솔98%，요추치입라정1226매,Ⅰ급라정1196，준학솔97.2%。매매라정적평균치정시간(7.0±1.5) min。215례획수방，수방시간(12±6)개월，무내고정물이위、단렬등병발증이급신경혈관손상발생。제시계산궤도항기술보조척주추궁근정치입，능입체、다시각실시현시골성해부결구，보증료척주추궁근정치입적준학성급안전성，명현감소방사선적폭로강도。
BACKGROUND:Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body. OBJECTIVE:To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.METHODS:307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical University from July 2008 to January 2014, were enrol ed in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which al owed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely. RESULTS AND CONCLUSION:Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69%). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were fol owed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.