基于三维荧光透视的原发性脊柱侵袭性肿瘤患者椎弓根螺钉置入导航

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors.

作者信息

Jin Bo, Su Yi-Bing, Zhao Ji-Zong

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050; China National Clinical Research Center for Neurological Diseases, Beijing 100050; Department of Neurosurgery, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing 100035, China.

Department of Neurosurgery, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing 100035, China.

出版信息

Chin Med J (Engl). 2016 Nov 5;129(21):2552-2558. doi: 10.4103/0366-6999.192777.

DOI:10.4103/0366-6999.192777

PMID:27779161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5125333/

Abstract

BACKGROUND

Although pedicle screw placement (PSP) is a well-established technique for spine surgery, the treatment of patients with primary invasive spinal tumor (PIST) has high surgical risks secondary to destroyed pedicles. Intraoperative three-dimensional fluoroscopy-based navigation (ITFN) system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration. The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.

METHODS

Fifty-one patients diagnosed with PISTs were retrospectively analyzed, and 157 pedicles screws were implanted in 23 patients using the free-hand technique (free-hand group) and 197 pedicle screws were implanted in 28 patients using the ITFN system (ITFN group). Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP, and McCormick classification was applied for assessment of neurological function. Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.

RESULTS

Of 51 patients, 39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same. In the free-hand group, 145 screws (92.4%) were Grade I, 9 screws (5.7%) were Grade II, and 3 screws (1.9%) were Grade III. In the ITFN group, 192 screws (97.4%) were Grade I, 5 screws (2.6%) were Grade II, and no Grade III screw was detected. Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different (χ2 = 4.981, P = 0.026).

CONCLUSIONS

The treatments of PISTs include total tumor resection and reconstruction of spine stability. The ITFN system provides a high accuracy of pedicle screw placement.

摘要

背景

尽管椎弓根螺钉置入术（PSP）是脊柱手术中一项成熟的技术，但原发性侵袭性脊柱肿瘤（PIST）患者的治疗因椎弓根遭到破坏而具有较高的手术风险。基于术中三维透视的导航（ITFN）系统能够安全、准确地进行脊柱器械置入，其优势在于可获取术中实时三维图像并自动配准。本研究旨在评估使用ITFN系统对胸椎PIST患者进行PSP的可行性和准确性。

方法

对51例诊断为PIST的患者进行回顾性分析，23例患者采用徒手技术植入157枚椎弓根螺钉（徒手组），28例患者使用ITFN系统植入197枚椎弓根螺钉（ITFN组）。采用改良的Gertzbein和Robbins分类法评估PSP的准确性，采用McCormick分类法评估神经功能。使用独立t检验比较人口统计学数据和影响螺钉置入准确性的因素，同时用卡方检验分析两组之间螺钉置入准确性的比较。

结果

51例患者中，39例神经状态改善，另外12例患者症状无变化。徒手组中，145枚螺钉（92.4%）为I级，9枚螺钉（5.7%）为II级，3枚螺钉（1.9%）为III级。ITFN组中，192枚螺钉（97.4%）为I级，5枚螺钉（2.6%）为II级，未检测到III级螺钉。统计分析表明，两组椎弓根螺钉的准确性有显著差异（χ2 = 4.981，P = 0.026）。