新型脊柱定位仪在椎弓根螺钉植入手术中的应用研究

摘要

Objective The aim of this study was to introduce a novel spinal location system for percutaneous pedicle screw placement and to evaluate the accuracy of puncture with the use of spinal location system in minimally invasive spine surgery (MISS).Methods The accuracy of puncture with the use of spinal location system in4 adult cadavers was evaluated.Forty-eight Kirschner wires were inserted into bilateral pedicle from L1 to S1 using spinal location system.The distances between the planned and actual puncture points on pedicles were measured.The excellent and good rate of Kirschner wire placement was evaluated according to the assessment standard of Richter.Results Using the spinal location system,48 Kirschner wires were implanted successfully and 96 puncture points were measured.The average distance between the planned and actual puncture points on lateral part of pedicle were 1.8 mm (X-ray anteroposterior view,A-P view) and 1.6 mm (X-ray lateral view,L view);the average distance on internal part of pedicle were 2.0 mm (A-P view) and 1.9 mm (L view);The average puncture distance deviation was 2.4 mm.The puncture results were excellent in 34 cases (70.8％),good in 10 cases (20.8％),and poor in 4 cases (8.3％).The excellent and good rate was 91.7％.Concluion Based on the resulting data,the novel spinal location system improves the accuracy in percutaneous spinal surgery,so it has exhibited a good technical and market prospect.%目的 设计一种新型脊柱定位仪,通过脊柱标本椎弓根穿刺验证定位仪的实用性与定位准确性.方法 自行设计一种脊柱定位仪,选择4具成人脊柱尸体标本,使用脊柱定位仪对尸体标本的椎弓根进行穿刺,测量椎弓根内、外缘的穿刺点与提前计划的理想穿刺点之间的距离,根据穿刺针的最大偏差数值计算穿刺的优良率.结果 共穿刺了尸体标本L1-S1的48个椎弓根,椎弓根外缘穿刺点与理想穿刺点的偏差距离在正位X光片上为:0～6.0 mm,平均1.8 mm;侧位X光片上为:0 ～7.0 mm,平均1.6mm.椎弓根内缘穿刺点与理想穿刺点的偏差距离为在正位X光片上为:0～6.4 mm,平均2.0 mm;侧位X光片上为:0～7.3 mm,平均1.9 mm.穿刺的最大偏差距离为:0～7.3 mm,平均2.4 mm.穿刺结果,优:34例(70.8％);良:10例(20.8％);差:4例(8.3％),优良率为91.7％.结论 新型脊柱定位仪在椎弓根穿刺试验中提高了穿刺的准确性,具有体积小巧、操作方便、精确性高等特点,具有较好的应用前景.