O形臂实时导航在颈椎椎弓根螺钉固定术中的应用
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作者Author单位AddressE-Mail
张超 ZHANG Chao 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China zhangchaongh@163.com 
刘玥 LIU Yue 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
吕游 LYU You 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
文天用 WEN Tian-yong 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
李超 LI Chao 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
何勍 HE Qing 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
阮狄克 RUAN Di-ke 解放军总医院第六医学中心骨科, 北京 100048 Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China  
期刊信息:《中国骨伤》2023年,第36卷,第5期,第487-489页
DOI:10.12200/j.issn.1003-0034.2023.05.017
基金项目:
中文摘要:

目的:探讨在O形臂导航下提高颈椎椎弓根螺钉置钉准确性的技术要点。

方法:对2015年12月至2020年1月接受O形臂导航下颈椎椎弓根钉内固定术治疗的21例患者进行回顾性分析,其中男15例,女6例,年龄29~76(45.3±11.5)岁。术后CT扫描以Gertzbein & Robbins分级评估颈椎弓根螺钉置钉的准确性。

结果: 21例患者共置入132枚椎弓根螺钉,其中116枚置于C3-C6节段,16枚置于环枢椎。术后CT扫描根据Gertzbein & Robbins分级,11.36%(15/132)打破椎弓根,其中73.33% (11/15)为B级,26.67% (4/15)为C级,无D-E级破壁。所有患者术后随访无内固定所致相关并发症。

结论:在合理选择适应证的前提下,O形臂导航下能够提高颈椎椎弓根螺钉置钉准确性和可靠性,使得手术医师更有信心进行复杂困难的颈椎内固定操作。但是考虑到颈椎弓根周围重要而复杂的邻近解剖结构,以及可能导致的灾难性后果,不仅应该熟练掌握导航技术要点,积累足够操作经验,同时警惕影像漂移,不应完全依赖导航。
【关键词】颈椎  椎弓根螺钉固定  术中导航
 
O-arm real-time guidance in cervical pedicle screw fixation
ABSTRACT  

Objective To explore the technical aspects of the accuracy of cervical pedicle screw placement with O-arm guidance.

Methods The clinical data of 21 patients who underwent cervical pedicle screw fixation by O-arm real-time guidance from December 2015 to January 2020 were analyzed retrospectively. There were 15 males and 6 females,aged from 29 to 76 years old with an average of (45.3±11.5) years. The postoperative CT scan was utilized to evaluate the placement of the pedicle screw and classified according to the Gertzbein and Robbins classification.

Results A total of 132 pedicle screws were implanted in 21 patients,116 at C3-C6 and 16 at C1 and C2. According to Gertzbein & Robbins classification,the overall breach rates were found to be 11.36% (15/132) with 73.33% (11 screws) Grade B,26.67% (4 screws) Grade C,and no Grade D or E screw breaches. There were no pedicle screw placement related complications at final follow-up.

Conclusion The application of O-arm real-time guidance technology can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon's confidence in using cervical pedicle instrumentation. Considering the high-risk nature of anatomical area around cervical pedicle and the possibility of catastrophic complications,the spine surgeon should have sufficient surgical skills,experience,ensures stringent verification of the system,and never relies solely on the navigation system.
KEY WORDS  Cervical spine  Trans-pedicle screw fixation  Intraoperative navigation
 
引用本文,请按以下格式著录参考文献:
中文格式:张超,刘玥,吕游,文天用,李超,何勍,阮狄克.O形臂实时导航在颈椎椎弓根螺钉固定术中的应用[J].中国骨伤,2023,36(5):487~489
英文格式:ZHANG Chao,LIU Yue,LYU You,WEN Tian-yong,LI Chao,HE Qing,RUAN Di-ke.O-arm real-time guidance in cervical pedicle screw fixation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):487~489
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