计算机断层扫描引导下胸椎椎弓根螺钉置入治疗青少年特发性脊柱侧凸可获得更准确的置钉和更少的螺钉取出。
Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal.
机构信息
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Spine (Phila Pa 1976). 2012 Apr 15;37(8):E473-8. doi: 10.1097/BRS.0b013e318238bbd9.
STUDY DESIGN
Retrospective study of computed tomography-guided navigation (CTGN) of thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis (AIS).
OBJECTIVE
To compare the accuracy and safety of thoracic pedicle screw placement and frequency of intraoperative removal using CTGN versus conventional freehand technique in AIS.
SUMMARY OF BACKGROUND DATA
Even in experienced hands, more than 10% of the thoracic pedicle screws are misplaced. CTGN may improve accuracy and safety, but there is little published data on its efficacy.
METHODS
We reviewed intraoperative computed tomographic images in a consecutive series of AIS cases undergoing posterior fusion during a 1-year period. Three types of screws were identified: an optimal screw--the central axis is in the plane and axis of the pedicle with the tip completely within the vertebral body; an acceptable screw--the majority of its shank is outside the central axis of the pedicle, but not potentially unsafe; and a potentially unsafe screw--(1) the central axis of the screw traversed the canal, (2) left anterior/lateral vertebral body perforation, risking the aorta, or (3) any screw repositioned or removed after the postimplant computed tomography.
RESULTS
In 42 patients, 485 screws were evaluable with a visible pedicle and screw (300 navigated and 185 non-navigated). Screws were classified as follows: optimal screws, 74% CTGN versus 42% non-navigated; acceptable screws, 23% CTGN versus 49% non-navigated; and potentially unsafe, 3% CTGN versus 9% non-navigated (P < 0.001). A potentially unsafe screw was 3.8 times less likely to be inserted with navigation (P = 0.003). The odds of a significant medial breach were 7.6 times higher without navigation (P < 0.001). A screw was 8.3 times more likely to be removed intraoperatively in the non-navigated cohort (P = 0.003).
CONCLUSION
CTGN resulted in more optimally placed thoracic pedicle screws, fewer potentially unsafe screws, and fewer screw removals.
研究设计
回顾性研究计算机断层扫描引导导航（CTGN）在青少年特发性脊柱侧凸（AIS）患者胸椎椎弓根螺钉置入中的应用。
目的
比较 CTGN 与传统徒手技术在 AIS 中胸椎椎弓根螺钉置入的准确性和安全性，以及术中移除的频率。
背景资料概要
即使在经验丰富的手中，也有超过 10%的胸椎椎弓根螺钉位置不当。CTGN 可能会提高准确性和安全性，但关于其疗效的文献数据很少。
方法
我们回顾了在 1 年内连续进行后路融合的 AIS 病例的术中计算机断层扫描图像。确定了三种类型的螺钉：理想螺钉-螺钉的中心轴在椎弓根的平面和轴线上，尖端完全在椎体内部；可接受螺钉-其大部分轴位于椎弓根中心轴之外，但不具有潜在危险性；以及潜在危险螺钉-（1）螺钉的中心轴穿过椎管，（2）左侧前/侧方椎体穿透，有损伤主动脉的风险，或（3）任何植入后计算机断层扫描后重新定位或移除的螺钉。
结果
在 42 例患者中，485 枚螺钉可评估（300 枚导航，185 枚非导航），可见椎弓根和螺钉。螺钉分类如下：理想螺钉，74%导航组与 42%非导航组；可接受螺钉，23%导航组与 49%非导航组；以及潜在危险螺钉，3%导航组与 9%非导航组（P <0.001）。使用导航时，潜在危险螺钉的插入可能性降低 3.8 倍（P=0.003）。没有导航时，显著内侧穿透的可能性高 7.6 倍（P<0.001）。非导航组术中螺钉移除的可能性增加 8.3 倍（P=0.003）。
结论
CTGN 可使更多的胸椎椎弓根螺钉放置更加理想，潜在危险螺钉更少，术中移除螺钉的情况也更少。
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