【摘要】：目的 :比較應(yīng)用三維導(dǎo)航與傳統(tǒng)C型臂X線機(jī)輔助經(jīng)皮椎弓根螺釘固定治療胸腰椎骨折手術(shù)的置釘準(zhǔn)確性與安全性。方法:我院2015年5月~2016年12月接受經(jīng)皮椎弓根螺釘內(nèi)固定手術(shù)的胸腰椎骨折患者53例,按置釘輔助設(shè)備的不同分為兩組:傳統(tǒng)組29例,螺釘置入在C型臂X線機(jī)輔助下完成;導(dǎo)航組24例,螺釘置入在三維導(dǎo)航系統(tǒng)輔助下完成。記錄每例患者術(shù)前腰背痛視覺(jué)模擬評(píng)分(visual analogue scale,VAS)、單枚螺釘置入時(shí)間、穿刺針調(diào)整次數(shù)、射線暴露時(shí)間、術(shù)中出血量、術(shù)后2d腰背部痛VAS評(píng)分及術(shù)后并發(fā)癥發(fā)生情況。根據(jù)術(shù)后CT來(lái)評(píng)估兩組置釘情況,依據(jù)Certzbein-Robbins改良分級(jí)來(lái)比較螺釘置入的準(zhǔn)確性和安全性,將Ⅰ類(lèi)螺釘所占比例定義為準(zhǔn)確率,Ⅰ類(lèi)和Ⅱ類(lèi)螺釘所占比例定義為安全率。隨訪期內(nèi)觀察圍患者并發(fā)癥發(fā)生情況及釘棒斷裂松脫情況。結(jié)果:兩組病例年齡、性別、術(shù)前腰背痛VAS評(píng)分、骨折類(lèi)型及骨折椎體分布情況無(wú)統(tǒng)計(jì)學(xué)差異。傳統(tǒng)組置釘準(zhǔn)確率為76.72%(89/116),安全率為95.69%(111/116);導(dǎo)航組置釘準(zhǔn)確率為90.63%(87/96),安全率為100%(96/96)。兩組患者術(shù)后均未發(fā)生神經(jīng)損傷等手術(shù)并發(fā)癥,無(wú)斷釘斷棒及螺釘松脫情況發(fā)生。導(dǎo)航組在術(shù)中穿刺針調(diào)整次數(shù)、術(shù)后2d腰背部痛VAS評(píng)分、置釘準(zhǔn)確率及安全率方面較傳統(tǒng)組有明顯優(yōu)勢(shì)(P0.05),在平均螺釘置入時(shí)間、術(shù)中出血量方面與傳統(tǒng)組無(wú)統(tǒng)計(jì)學(xué)差異,在術(shù)中射線暴露時(shí)間方面明顯長(zhǎng)于傳統(tǒng)組(P0.05)。結(jié)論:三維導(dǎo)航技術(shù)能顯著提高胸腰椎骨折經(jīng)皮椎弓根螺釘置入的準(zhǔn)確性和安全性,但患者會(huì)受到更長(zhǎng)時(shí)間的射線暴露。
[Abstract]:Objective: to compare the accuracy and safety of three-dimensional navigation and conventional C-arm X-ray machine assisted percutaneous pedicle screw fixation for thoracolumbar fractures. Methods: from May 2015 to December 2016, 53 patients with thoracolumbar fractures underwent percutaneous pedicle screw internal fixation in our hospital were divided into two groups according to the difference of screw insertion aids: the traditional group (29 cases), the screws were implanted with C-arm X-ray machine. In the navigation group, 24 cases were performed with screw placement assisted by three-dimensional navigation system. The preoperative visual analogue score (visual analogue scale,VAS) of low back pain, the time of placement of single screw, the adjusting times of puncture needle, the time of radiation exposure, the amount of intraoperative bleeding, the VAS score of lumbar and back pain 2 days after operation and the occurrence of postoperative complications were recorded in each patient. The accuracy and safety of screw placement were compared according to the modified Certzbein-Robbins classification. The ratio of type I screws was defined as accuracy rate, and the proportion of type 鈪，

本文編號(hào)：2201454