Arand M, Teller S, Gebhard F, Schultheiss M, Keppler P
Klinikum Ludwigsburg, Akademisches Lehrkrankenhaus der Universität Heidelberg.
Z Orthop Unfall. 2008 Jul-Aug;146(4):458-62. doi: 10.1055/s-2008-1038539.
The aim of the present study was the verification of the accuracy of 2-D fluoroscopy-based navigated pedicle screws at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws in 29 patients were instrumented using C-arm based navigation, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin slice CT scan using multiplanar reconstruction. The position of a screw in relation to its pedicle was classified in a) screw completely intraosseous, b) screw perforated less than thread level and c) screw perforated more than thread level. In 34 thoracic (56.7%) and 32 lumbar (62.7%) screws complete intraosseous placement was observed, 14 thoracic (23.3%) and 14 lumbar (27.5%) screws perforated less than thread level. Perforations more than thread level were found in 12 thoracic (20%) and 5 lumbar (9.8%) screws. Only medial and lateral perforations of the pedicle were documented (without neurological signs), cranial or caudal ones did not occur. Segmentation of the C-arm navigation into two comparable treatment periods showed a learning curve with a reduction of perforations in the second sequence (after 57 pedicle instrumentations) of about 15%, this was found to be not statistically significant. The fluoroscopic navigation of pedicle screws is a safe procedure at the lumbar spine with equal accuracy compared to the non-navigated conventional instrumentation. Application of C-arm navigation at the thoracic spine showed more inaccuracies, so that 3-D-based navigation seems to be advantageous in this region.
本研究的目的是在一组创伤患者中验证基于二维荧光透视导航的胸腰椎椎弓根螺钉的准确性。在36个月内，对29例患者的111枚椎弓根螺钉使用基于C型臂的导航进行植入，其中胸椎60枚，腰椎51枚。术后通过常规薄层CT扫描及多平面重建对所有螺钉位置进行评估。根据螺钉与椎弓根的关系，将螺钉位置分为：a）螺钉完全位于骨内；b）螺钉穿孔小于螺纹水平；c）螺钉穿孔大于螺纹水平。在34枚胸椎螺钉（56.7%）和32枚腰椎螺钉（62.7%）中观察到完全骨内植入，14枚胸椎螺钉（23.3%）和14枚腰椎螺钉（27.5%）穿孔小于螺纹水平。在12枚胸椎螺钉（20%）和5枚腰椎螺钉（9.8%）中发现穿孔大于螺纹水平。仅记录了椎弓根的内侧和外侧穿孔（无神经症状），未出现头侧或尾侧穿孔。将C型臂导航分为两个可比的治疗阶段，结果显示存在学习曲线，在第二个阶段（57枚椎弓根植入后）穿孔减少约15%，但差异无统计学意义。与非导航的传统器械相比，椎弓根螺钉的荧光透视导航在腰椎是一种安全且准确性相当的操作。在胸椎应用C型臂导航显示出更多的不准确性，因此基于三维的导航在该区域似乎更具优势。
