Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria.
World Neurosurg. 2018 Jan;109:e24-e32. doi: 10.1016/j.wneu.2017.09.091. Epub 2017 Sep 22.
BACKGROUND: Recent studies have shown higher accuracy rates of image-guided pedicle screw placement compared to freehand (FH) placement. However, data focusing on the impact of spinal navigation on the rate of revision surgeries caused by misplaced pedicle screws (PS) are scarce. OBJECTIVE: This study is aimed at identifying the rate of revision surgeries for misplaced PS comparing three-dimensional (3D) fluoroscopy navigation (3DFL) with FH PS placement. METHODS: A retrospective analysis was conducted of 2232 patients (mean age, 65.3 ± 13.5 years) with 13,703 implanted PS who underwent instrumentation of the thoracolumbar spine between 2007 and 2015. Group 1 received surgery with use of 3DFL (January 2011 to December 2015), group 2 received surgery in the FH technique (April 2007 to December 2015). Because the use of 3DFL was initiated in January 2011, the examined period for 3DFL-navigated surgeries is shorter. Patients routinely received postoperative computed tomography scans and/or intraoperative control 3D scans. RESULTS: There was an overall rate of revision surgeries for malpositioned PS of 2.9%. In the 3DFL group, the rate of secondary revision surgeries was significantly lower with 1.35% (15/1112 patients) compared to 4.38% (49/1120 patients) in the FH group, respectively (odds ratio, 3.35; P < 0.01). Of all PS in the 3DFL group (30/7548 PS), 0.40% needed revision surgery (P < 0.01) compared to 1.14% in the FH group (70/6155 PS). CONCLUSIONS: We were able to show that the use of 3DFL-navigated PS placement significantly reduces the rate of revision surgeries after posterior spinal instrumentation compared to freehand PS placement.
背景：最近的研究表明，与徒手（FH）置钉相比，影像引导椎弓根螺钉置入的准确率更高。然而，目前针对脊柱导航对因椎弓根螺钉（PS）置钉位置不当而导致的翻修手术率影响的数据还很少。
目的：本研究旨在比较三维（3D）透视导航（3DFL）与 FH PS 置钉，确定因 PS 位置不当而需要翻修手术的比率。
方法：对 2007 年至 2015 年间接受胸腰椎脊柱内固定术的 2232 例患者（平均年龄 65.3 ± 13.5 岁）的 13703 枚植入 PS 进行回顾性分析。第 1 组接受 3DFL 手术（2011 年 1 月至 2015 年 12 月），第 2 组接受 FH 技术手术（2007 年 4 月至 2015 年 12 月）。因为 3DFL 是从 2011 年 1 月开始使用的，所以 3DFL 导航手术的检查期较短。患者常规接受术后计算机断层扫描和/或术中控制 3D 扫描。
结果：PS 位置不当导致的翻修手术总体发生率为 2.9%。3DFL 组继发性翻修手术的发生率明显低于 FH 组（分别为 1.35%[1112 例患者中的 15 例]和 4.38%[1120 例患者中的 49 例]）（比值比，3.35；P < 0.01）。3DFL 组的所有 PS 中（7548 枚 PS 中的 30 枚），有 0.40%需要翻修手术（P < 0.01），而 FH 组（6155 枚 PS 中的 70 枚）为 1.14%。
结论：与徒手 PS 置钉相比，使用 3DFL 导航 PS 置钉可显著降低后路脊柱内固定术后翻修手术的发生率。
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