Merloz P, Tonetti J, Pittet L, Coulomb M, Lavallée S, Troccaz J, Cinquin P, Sautot P
University Department of Orthopaedic Surgery, CHU A. Michallon, Grenoble, France.
Comput Aided Surg. 1998;3(6):297-305. doi: 10.1002/(SICI)1097-0150(1998)3:6<297::AID-IGS3>3.0.CO;2-8.
The aim of this study was to improve the reliability of pedicle screw insertion. Transpedicle screw insertion may cause neurological, vascular, and mechanical complications. Previous studies of surgical procedures have shown a significant rate of incorrect placement of the screw ranging from 10 to 40%. A new technique that combines preoperative computed tomography (CT) imaging with intraoperative passive navigation was used to perform 64 pedicle screw insertions in the thoracolumbar region. At the same time, 64 pedicle screw insertions were performed manually in the same region and on the same vertebral levels. Surgery was followed in all cases by postoperative radiographs and computed tomography examination, which allowed measurements of screw position relative to pedicle position to be performed. A comparison between the two groups showed that six screws in 64 vertebra (9%) had incorrect placement with the computer-assisted technique whereas 28 screws in 64 vertebra (44%) had incorrect placement with manual insertion. The intraoperative accuracy provided by the computer after registration was better than 1 mm. The good results obtained are similar to those reported in the literature. The cortex penetration observed with the computer-assisted technique was not imputed to computer failure. Errors by the surgeon in acquiring data in the pre- and perioperative steps may explain the six incorrect screw placements. This clinical experience confirms that the accuracy and the reliability of this computer-assisted technique are good.
本研究的目的是提高椎弓根螺钉植入的可靠性。经椎弓根螺钉植入可能会导致神经、血管和机械性并发症。先前关于手术操作的研究表明，螺钉放置错误的发生率高达10%至40%。一种将术前计算机断层扫描（CT）成像与术中被动导航相结合的新技术，被用于在胸腰段进行64例椎弓根螺钉植入。同时，在同一区域和相同椎体水平上手动进行64例椎弓根螺钉植入。所有病例术后均进行了X线片和计算机断层扫描检查，从而能够测量螺钉相对于椎弓根位置的情况。两组之间的比较显示，采用计算机辅助技术在64个椎体中有6枚螺钉（9%）放置错误，而手动植入时在64个椎体中有28枚螺钉（44%）放置错误。计算机在注册后提供的术中精度优于1毫米。所获得的良好结果与文献报道的结果相似。计算机辅助技术观察到的皮质穿透并非归因于计算机故障。外科医生在术前和围手术期步骤中获取数据时的失误可能解释了6枚螺钉放置错误的原因。这一临床经验证实了这种计算机辅助技术的准确性和可靠性良好。
