本文選題：頸椎　切入點(diǎn)：X線　出處：《中國(guó)組織工程研究》2017年11期 　論文類型：期刊論文

【摘要】：背景:臨床上頸椎椎弓根導(dǎo)航方法相對(duì)較多,均能提高圍術(shù)期置釘準(zhǔn)確率,但是這些導(dǎo)航系統(tǒng)尚存在許多不完善之處,如圖像質(zhì)量不高、操作復(fù)雜繁瑣、實(shí)時(shí)性差或?qū)Ш酱嬖趧?chuàng)傷性等,難以達(dá)到預(yù)期的置釘效果。目的:對(duì)比X射線透視輔助徒手法與CT三維圖像導(dǎo)航下頸椎椎弓根置釘?shù)臏?zhǔn)確率。方法:取南陽(yáng)醫(yī)學(xué)高等�？茖W(xué)校第一附屬醫(yī)院收治的頸椎椎弓根置釘患者90例,隨機(jī)分為2組(n=45),徒手組在X射線透視輔助下徒手法置入132枚頸椎椎弓根螺釘,三維導(dǎo)航組在CT三維圖像導(dǎo)航下置入128枚頸椎椎弓根螺釘,記錄2組置釘時(shí)間、出血量;2組術(shù)后均行CT平掃,完成三維重建,比較2組頸椎椎弓根螺釘置釘準(zhǔn)確率。結(jié)果與結(jié)論:(1)三維導(dǎo)航組圍術(shù)期置釘優(yōu)良率95.3%顯著高于徒手組88.6%(P0.05);(2)三維導(dǎo)航組置釘時(shí)間顯著長(zhǎng)于徒手組(P0.05),置釘出血量顯著多于徒手組(P0.05),導(dǎo)航匹配時(shí)間及輻射量小于徒手組(P0.05);(3)2組術(shù)前JOA評(píng)分比較差異無顯著性意義(P0.05);三維導(dǎo)航組術(shù)后3,6個(gè)月JOA評(píng)分均顯著高于徒手組(P0.05);(4)三維導(dǎo)航組并發(fā)癥發(fā)生率7%低于徒手組16%(P0.05);(5)結(jié)果提示,與X射線透視輔助徒手法置釘相比,CT三維圖像導(dǎo)航能提高頸椎椎弓根置釘準(zhǔn)確率,提高手術(shù)安全和精確性。但是CT三維圖像導(dǎo)航置釘方法操作相對(duì)繁瑣,耗費(fèi)時(shí)間較長(zhǎng),造成患者術(shù)中出血量較大,應(yīng)根據(jù)患者情況選擇合適的置釘方法。
[Abstract]:Background: there are many clinical methods of cervical pedicle navigation, which can improve the accuracy of perioperative nail placement. However, these navigation systems still exist many imperfections, such as low image quality and complicated operation. Poor real-time or traumatic navigation, etc. Objective: to compare the accuracy rate of cervical pedicle screw placement with X-ray fluoroscopy assisted bare-hand method and CT three-dimensional image navigation. Methods: the first affiliated Hospital of Nanyang Medical College was selected and admitted to Nanyang Medical College. A total of 90 cases of cervical pedicle screw insertion were reported. Two groups were randomly divided into two groups: the bare-handed group was assisted by X-ray fluoroscopy, 132 cervical pedicle screws were inserted with the aid of X-ray fluoroscopy, and 128 cervical pedicle screws were placed in the three-dimensional navigation group under the guidance of CT three-dimensional image, and the time of fixation in the two groups was recorded. In both groups, CT scan was performed before and after operation, and 3D reconstruction was completed. Results and conclusion the excellent and good rate of screw insertion in the 3 D navigation group was significantly higher than that in the bare hand group (88. 6% P 0. 05) the time of nail placement in the 3 D navigation group was significantly longer than that in the bare hand group (P 0. 05%) and the blood loss was significantly higher in the 3 D navigation group than in the bare hand group (P 0. 05). There was no significant difference in the preoperative JOA score between the two groups (P 0.05), and the JOA score in the 3 D navigation group was significantly higher than that in the 3 D navigation group at 3 and 6 months after operation (P 0. 05%, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). The results indicated that the rate of 7% was lower than that of the bare hand group. Compared with X-ray fluoroscopy assisted manual nail placement, CT 3D image navigation can improve the accuracy of cervical pedicle screw placement, and improve the safety and accuracy of surgery, but the operation of CT 3D image navigation nail placement method is relatively cumbersome and time-consuming. Due to the large amount of blood loss during operation, the proper method of nail placement should be selected according to the patient's condition.
【作者單位】： 南陽(yáng)醫(yī)學(xué)高等專科學(xué)校第一附屬醫(yī)院放射科;南陽(yáng)醫(yī)學(xué)高等�？茖W(xué)校第一附屬醫(yī)院神經(jīng)內(nèi)科;
【基金】：河南省衛(wèi)生科技攻關(guān)項(xiàng)目(2014HNA0122)~~
【分類號(hào)】：R687.3;R816.8

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