CT导航辅助下椎弓根置钉术在椎体旋转型脊柱畸形矫正术中的应用研究

摘要

目的:探讨CT导航辅助下椎弓根置钉术在椎体旋转型脊柱畸形矫正术中的应用价值.方法:回顾性分析2009～2012年于解放军某医院脊柱外科行脊柱矫形手术的椎体旋转型脊柱畸形患者100例,根据术中是否采用CT导航辅助分为导航组(n=37)及非导航组(n=63);根据椎体旋转程度的不同,每组再分为4个亚组(G1、G2、G3、G4组).置钉完毕后,行术中CT扫描三维重建,并进行置钉准确性分级(Ⅰ级螺钉:位置良好;Ⅱ、Ⅲ级螺钉:误置螺钉,需重新置入),分析并比较两组存在椎体旋转时椎弓根置钉的准确性.结果:导航组总置钉破出率及误置返修率均低于非导航组(P＜0.01).两组的G1、G2亚组置钉准确率比较,差异无统计学意义;导航组G3、G4亚组置钉准确率明显高于非导航组(P＜0.01).结论:当椎体旋转角度＞10°时,术中CT导航辅助下椎弓根置钉技术可提高脊柱矫形手术的置钉准确性.%Objective:To explore the clinical value of intraoperative CT navigation for pedicle screws placement in surgical correction of spinal deformity with vertebral rotation.Methods:A total of 100 patients with spinal deformity and vertebral rotation in our hospital from 2009 to 2012 were retrospectively analyzed.All patients were divided into navigation group(n =37) and non-navigation group (n--63).Each group were divided into 4 subgroups (G1,G2,G3,G4 group).After all screws placement completed,CT scan was taken three dimensional reconstruction,and was given assess accuracy of each screw.Broken screws rate,malposition and revision rate of each group were calculated and analyzed.Results:Broken screws rate,mollposition and revision rate in navigation group were lower than those in non-navigation group(P＜0.01).Accuracy rates of G3,G4 sub groups in navigation group were higher than those in non-natigation group(P ＜0.01).Conclusion:Intraoperative CT navigation can improve the accuracy of pedicle screws placement when degree of vertebral rotation exceed 10°.