Zhang Wei, Takigawa Tomoyuki, Wu YongGang, Sugimoto Yoshihisa, Tanaka Masato, Ozaki Toshifumi
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
Department of Orthopaedic Surgery, Bayannaoer City Hospital, Bayannaoer, Inner Mongolia, China.
Eur Spine J. 2017 Jun;26(6):1756-1764. doi: 10.1007/s00586-016-4930-5. Epub 2016 Dec 27.
This study was conducted to compare the efficacy and accuracy of intraoperative navigation (O-arm or Arcadis navigation) and preoperative CT-based navigation in adolescent idiopathic scoliosis (AIS) surgery.
Sixty-seven patients with scoliosis were grouped according to the method of navigation used in their fixation surgeries. A total of 492 pedicle screws were implanted in 27 patients using intraoperative navigation, and 626 screws were implanted in 40 patients using preoperative navigation. We analyzed the postoperative CT images for pedicle violations using the Gertzbein classification.
There was no statistical difference in the accuracy of pedicle screw placement between two groups. However, in the apical region (the apex ± 2 vertebrae), the accuracy of safe pedicle screw placement (grades 0, 1) was significantly higher in the intraoperative navigation group than in the preoperative navigation group (94.8 vs 89.2%, respectively; P = 0.035). Intraoperative navigation significantly diminished medial perforation compared to preoperative navigation (P = 0.027), and the number of screws per vertebra that could be placed in the apical region was significantly higher in intraoperative navigation group (P < 0.001). In addition, the time required for the registration procedure and insertion of one pedicle screw was 11.3 ± 2.1 min in the preoperative group, but significantly decreased to 5.1 ± 1.1 min in the intraoperative group (P < 0.001).
Both preoperative CT-based and intraoperative navigation systems provide sufficient accuracy and safety in pedicle screw insertion for AIS surgery. Intraoperative navigation systems facilitate pedicle screw insertion in the apical region and reduce registration time during AIS surgery which improves the efficacy and accuracy of pedicle screw insertion.
本研究旨在比较术中导航（O型臂或Arcadis导航）和基于术前CT的导航在青少年特发性脊柱侧凸（AIS）手术中的疗效和准确性。
67例脊柱侧凸患者根据其固定手术中使用的导航方法进行分组。27例患者使用术中导航植入了492枚椎弓根螺钉，40例患者使用术前导航植入了626枚螺钉。我们使用Gertzbein分类法分析术后CT图像中椎弓根侵犯情况。
两组椎弓根螺钉置入的准确性无统计学差异。然而，在顶椎区域（顶椎±2个椎体），术中导航组安全椎弓根螺钉置入（0级、1级）的准确性显著高于术前导航组（分别为94.8%和89.2%；P = 0.035）。与术前导航相比，术中导航显著减少了内侧穿孔（P = 0.027），术中导航组在顶椎区域每个椎体可置入的螺钉数量显著更高（P < 0.001）。此外，术前组注册程序和置入一枚椎弓根螺钉所需时间为11.3 ± 2.1分钟，但术中组显著缩短至5.1 ± 1.1分钟（P < 0.001）。
基于术前CT的导航系统和术中导航系统在AIS手术的椎弓根螺钉置入中均提供了足够的准确性和安全性。术中导航系统便于在顶椎区域置入椎弓根螺钉，并减少了AIS手术中的注册时间，从而提高了椎弓根螺钉置入的疗效和准确性。
