Arand M, Schempf M, Hebold D, Teller S, Kinzl L, Gebhard F
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie, Universität, Ulm.
Unfallchirurg. 2003 Nov;106(11):899-906. doi: 10.1007/s00113-003-0687-5.
The goal of these studies was to evaluate the accuracy of in vivo and in vitro application of CT- and C-arm-based navigation at the thoracic and lumbar spine. With CT based navigation, 82 pedicle screws were consecutively inserted, 53 into the thoracic and 29 into the lumbar spine. Seven (13%) perforations were detected at the thoracic spine and two (7%) at the lumbar spine. Additionally, minor perforations below the thread depth were seen in six (11%) thoracic and in two (7%) lumbar instrumentation. With C-arm-based navigation, 74 screws were consecutively placed into 38 thoracic and 36 lumbar pedicles. Perforations were noted in ten (26%) thoracic and four (11%) lumbar implants. Minor perforations were observed in another nine (24%) thoracic and ten (28%) lumbar pedicles. The observer-independent and standardized in vitro study based on a transpedicular 3.2-mm drill hole aiming a 4-mm steel ball in a plastic bone model showed pedicle perforations of the drill canal only in thoracic vertebrae, 1 of 15 in CT-based and 3 of 15 in C-arm navigation. The quantitative calculation of the smallest distance between the central line through the drill canal and the center of the steel ball resulted in 1.4 mm (0.5-4.8 mm) for the CT-based navigation at the thoracic spine and in 1.8 mm (0.5-3 mm) at the lumbar spine. For the C-arm based navigation the distance was 2.6 mm (0.9-4.8 mm) for the thoracic spine and 2 mm (1.2-3 mm) for the lumbar spine. In our opinion, the clinical results of the comparative accuracy of CT- and C-arm-based navigation in the present study showed moderate advantages of the CT-based technique in the thoracic spine, whereas CT- and C-arm based navigation had comparable perforation rates at the lumbar pedicle. The results of the experimental study correlated with the clinical data.
这些研究的目的是评估基于CT和C型臂的导航技术在胸椎和腰椎的体内及体外应用的准确性。采用基于CT的导航技术，连续植入82枚椎弓根螺钉，其中53枚植入胸椎，29枚植入腰椎。在胸椎发现7例（13%）穿孔，在腰椎发现2例（7%）穿孔。此外，在6例（11%）胸椎和2例（7%）腰椎器械植入中，发现螺纹深度以下有轻微穿孔。采用基于C型臂的导航技术，连续将74枚螺钉置入38个胸椎和36个腰椎椎弓根。在10例（26%）胸椎和4例（11%）腰椎植入物中发现穿孔。在另外9例（24%）胸椎和10例（28%）腰椎椎弓根中观察到轻微穿孔。在塑料骨模型中，基于经椎弓根3.2毫米钻孔并以4毫米钢球为目标的观察者独立且标准化的体外研究显示，仅在胸椎出现钻孔通道的椎弓根穿孔，基于CT的导航技术中15例中有1例，C型臂导航技术中15例中有3例。通过钻孔通道中心线与钢球中心之间最小距离的定量计算，基于CT的导航技术在胸椎处为1.4毫米（0.5 - 4.8毫米），在腰椎处为1.8毫米（0.5 - 3毫米）。对于基于C型臂的导航技术，胸椎处的距离为2.6毫米（0.9 - 4.8毫米），腰椎处为2毫米（1.2 - 3毫米）。我们认为，本研究中基于CT和C型臂的导航技术比较准确性的临床结果显示，基于CT的技术在胸椎方面有适度优势，而在腰椎椎弓根处，基于CT和C型臂的导航技术穿孔率相当。实验研究结果与临床数据相关。
