Liu Yijie, Li Xuefeng, Sun Han, Yang Huilin, Jiang Weimin
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University 188 Shizi Street, Suzhou 215006, China.
Int J Clin Exp Med. 2015 Oct 15;8(10):18889-93. eCollection 2015.
There has been a large series in the literature reporting on results of osteotomy for the correction of kyphotic deformity secondary to post-traumatic thoracolumbar fracture. However, there are few reports on using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, transpedicular wedge osteotomy for the correction of kyphotic deformity in old thoracolumbar fracture. A 45-year-old woman with L1 old fracture, presented to us with a Cobb angle of 45 degrees. The preoperative standard anteroposterior, lateral views and computed tomography (CT) reconstructions revealed kyphotic deformity. After attaching the reference arc of the 3D-imaging system, the thoracolumbar spine was screened using an O-arm without anatomical registration. The location, angle and depth of osteotomy, as well as screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The surgery was successful without nervous and vascular injuries. Using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, the transpedicular wedge osteotomy is a safe and effective treatment for kyphosis after the thoracolumbar fracture, which can insert the pedicular screw accurately, trace the real-time wedge osteotomy and reduce the loss of correction of kyphotic deformity.
文献中有大量系列报道了用于矫正创伤后胸腰椎骨折继发后凸畸形的截骨术结果。然而，关于使用基于术中全旋转三维图像（O型臂）导航的经椎弓根楔形截骨术矫正陈旧性胸腰椎骨折后凸畸形的报道较少。一名45岁L1陈旧性骨折女性患者前来就诊，其Cobb角为45度。术前标准正位、侧位X线片及计算机断层扫描（CT）重建显示有后凸畸形。在连接三维成像系统的参考弧后，使用O型臂对胸腰椎进行扫描，无需进行解剖配准。在参考重建的三维解剖图像的同时，使用导向管进行截骨的位置、角度和深度以及螺钉固定。手术成功，未发生神经和血管损伤。基于术中全旋转三维图像（O型臂）导航的经椎弓根楔形截骨术是治疗胸腰椎骨折后后凸畸形的一种安全有效的方法，它可以精确植入椎弓根螺钉，实时追踪楔形截骨，并减少后凸畸形矫正丢失。
