發(fā)布時間：2018-07-03 06:15

  本文選題：術(shù)中三維CT導(dǎo)航 + 椎弓根螺釘��； 參考：《中國人民解放軍醫(yī)學(xué)院》2015年碩士論文

【摘要】：[目的]通過與徒手置釘技術(shù)的比較,探討在后路全椎弓根螺釘治療脊柱畸形手術(shù)中,術(shù)中三維CT導(dǎo)航輔助下置釘技術(shù)的準(zhǔn)確性優(yōu)勢及臨床價值。[方法]回顧分析2009年6月至2012年9期間,于我院脊柱外科行脊柱畸形矯形手術(shù)并行術(shù)中CT輔助檢查的連續(xù)100個病例,所有病例非隨機分為導(dǎo)航組及非導(dǎo)航組,其中導(dǎo)航組37例,非導(dǎo)航組63例。分組方法：1)根據(jù)椎弓根釘置入節(jié)段的不同,將兩組病例各分為胸椎、上胸椎、中胸椎、下胸椎及腰椎5個亞組；2)根據(jù)椎體旋轉(zhuǎn)程度的不同,將每組病例的椎弓根螺釘分為4個亞組(G1=0°, 0G2"f10°,10°G3"f20°,G420°,導(dǎo)航G1組表示以G1。組表示,非導(dǎo)航G1組以G1F組表示,以此類推)。當(dāng)每個病例所有椎弓根螺釘置入完畢后,行術(shù)中CT掃描并三維重建,根據(jù)重建圖像評定螺釘準(zhǔn)確性并予以分級,Ⅱ級和Ⅲ級螺釘評定為誤置螺釘并重新置入。比較并分析兩組整體間及各亞組間椎弓根螺釘?shù)闹冕敎?zhǔn)確性,以及在不同椎體旋轉(zhuǎn)程度的情況下,導(dǎo)航組和非導(dǎo)航組椎弓根置釘?shù)钠瞥雎屎驼`置返修率。[結(jié)果]導(dǎo)航組37例患者男性19例,女性18例,年齡3～77歲,平均25.03±18.58歲,非導(dǎo)航組63例患者男性28例,女性35例,年齡3～63歲,平均18.87±12.04歲,兩組年齡及性別均無統(tǒng)計學(xué)差異(P年齡=0.5291,P性別=0.1307)。導(dǎo)航組總體椎弓根置釘準(zhǔn)確率(94.61%)高于非導(dǎo)航組(88.43%)(P0.05),返修率(2.43%)低于非導(dǎo)航組(6.06%)(P0.05)。各亞組間比較,導(dǎo)航胸椎組、中胸椎組、下胸椎組椎弓根置釘準(zhǔn)確率均高于非導(dǎo)航對應(yīng)組(P0.05),返修率均低于非導(dǎo)航對應(yīng)組(P0.05)；兩組上胸椎組間及腰椎組間準(zhǔn)確率及返修率差異均無統(tǒng)計學(xué)意義(P0.05)。按旋轉(zhuǎn)程度分類比較,G1N組和G2N組的置釘破出率及誤置返修率與G1F組和G2F組無統(tǒng)計學(xué)差異(P0.05),但G3N組和G4N組的置釘破出率及誤置返修率明顯低于G3F組和G4F組(P0.05)。[結(jié)論]術(shù)中三維CT導(dǎo)航技術(shù)可提高脊柱矯形手術(shù)中的椎弓根螺釘置釘準(zhǔn)確性,尤其是胸椎弓根置釘以及椎體旋轉(zhuǎn)角度大于10。時的置釘準(zhǔn)確性。
[Abstract]:[objective] to evaluate the accuracy and clinical value of 3 D CT navigation assisted screw placement in posterior total pedicle screw surgery for spinal deformity by comparing with the technique of free hand screw insertion. [methods] from June 2009 to September 2012, 100 consecutive cases of spinal deformities underwent orthopedic surgery and intraoperative CT assisted examination in our hospital were analyzed retrospectively. All the cases were not randomly divided into navigation group and non-navigation group. There were 37 cases in navigation group and 63 cases in non-navigation group. Methods: 1) according to the different pedicle screw placement, the two groups were divided into 5 subgroups: thoracic vertebra, upper thoracic vertebra, middle thoracic vertebra, lower thoracic vertebra and lumbar vertebrae) according to the degree of vertebral rotation, the two groups were divided into 5 subgroups: thoracic vertebra, upper thoracic vertebra, middle thoracic vertebra, lower thoracic vertebra and lumbar vertebrae. The pedicle screws of each group were divided into 4 subgroups (G 1 0 擄, 0 G 2 "f 10 擄10 擄10 擄G 3" f 20 擄G 420 擄, G 1 group was expressed as G 1. The non-navigation G1 group is represented by the G 1 F group, and so on. After all pedicle screws were implanted in each case, CT scan and 3D reconstruction were performed during the operation. The accuracy of the screws was evaluated and graded according to the reconstructed images, and the grade 鈪，

本文編號：2092704