Wu Han, Gao Zhong-li, Wang Jin-cheng, Li Ying-pu, Xia Peng, Jiang Rui
Deparment of Orthopaedics, China-Japan Union Hospital, Jilin University, Changchun, China.
Chin J Traumatol. 2010 Aug 1;13(4):201-5.
To evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques.
Total 176 thoracic pedicle screws placed in 42 thoracic fracture patients were involved in the study randomly, 20 patients under conventional fluoroscopic control (84 screws) and 22 patients had screw insertion under three dimensional (3D) computer-assisted navigation (92 screws). The 2 groups were compared for accuracy of screw placement, time for screw insertion by postoperative thin-cut CT scans and statistical analysis by X(2) test. The cortical perforations were then graded by 2-mm increments: Grade I (good, no cortical perforation), Grade II (screw outside the pedicle less than 2 mm), Grade III (screw outside the pedicle larger than 2 mm).
In computer assisted group, 88 (95.65%) were Grade I (good), 4 (4.35%) were Grade II (less than 2mm), no Grade III (larger than 2 mm) violations. In conventional group, there were 14 cortical violations (16.67%), 70 (83.33%) were Grade I (good), 11 (13.1%) were Grade II (less than 2 mm), and 3 (3.57%) were Grade III (larger than 2 mm) violations (P less than 0.001). The number (19.57%) of upper thoracic pedicle screws ( T(1)-T(4) ) inserted under 3D computer-assisted navigation was significantly higher than that (3.57%) by conventional fluoroscopic control (P less than 0.001). Average screw insertion time in conventional group was (4.56+/-1.03) min and (2.54+/-0.63) min in computer assisted group (P less than 0.001). In the conventional group, one patient had pleura injury and one had a minor dura violation.
This study provides further evidence that 3D computer-assisted navigation placement of pedicle screws can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly upper thoracic spine.
评估计算机辅助椎弓根螺钉置入的准确性及其与传统椎弓根螺钉置入技术相比的临床益处。
本研究随机纳入42例胸椎骨折患者置入的176枚胸椎椎弓根螺钉，其中20例患者在传统透视引导下置入（84枚螺钉），22例患者在三维（3D）计算机辅助导航下置入螺钉（92枚螺钉）。通过术后薄层CT扫描比较两组螺钉置入的准确性、螺钉置入时间，并采用X²检验进行统计学分析。然后将皮质穿孔按2毫米增量分级：I级（良好，无皮质穿孔），II级（螺钉位于椎弓根外小于2毫米），III级（螺钉位于椎弓根外大于2毫米）。
计算机辅助组中，88枚（95.65%）为I级（良好），4枚（4.35%）为II级（小于2毫米），无III级（大于2毫米）违规情况。传统组中，有14例皮质违规（16.67%），70枚（83.33%）为I级（良好），11枚（13.1%）为II级（小于2毫米），3枚（3.57%）为III级（大于2毫米）违规（P<0.001）。在3D计算机辅助导航下置入的上胸椎椎弓根螺钉（T₁-T₄）数量（19.57%）显著高于传统透视引导下的数量（3.57%）（P<0.001）。传统组平均螺钉置入时间为（4.56±1.03）分钟，计算机辅助组为（2.54±0.63）分钟（P<0.001）。在传统组中，1例患者发生胸膜损伤，1例患者发生轻度硬脊膜损伤。
本研究进一步证明，3D计算机辅助导航置入椎弓根螺钉可提高准确性、减少手术时间，并且在胸椎各节段，尤其是上胸椎，均可安全有效地进行。
