术中使用 O 臂导航置入螺钉时出现椎弓根穿孔：青少年特发性脊柱侧凸的危险因素和置入顺序的影响。
Pedicle Perforation While Inserting Screws Using O-arm Navigation During Surgery for Adolescent Idiopathic Scoliosis: Risk Factors and Effect of Insertion Order.
机构信息
Department of Orthopaedic Surgery, University of Yamanashi, School of Medicine, Chuo, Yamanashi, Japan.
Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto, Nagano, Japan.
出版信息
Spine (Phila Pa 1976). 2018 Dec 15;43(24):E1463-E1468. doi: 10.1097/BRS.0000000000002737.
STUDY DESIGN
An observational cohort study.
OBJECTIVE
The aim of this study was to compare the rate of pedicle perforation while inserting screws (PS) using O-arm navigation during surgery for scoliosis with that reported previously and to determine the risk factors specific to O-arm navigation.
SUMMARY OF BACKGROUND DATA
O-arm navigation provides intraoperative three-dimensional fluoroscopic imaging with an image quality similar to that of computed tomography. Surgeons have started using O-arm navigation in treatment of adolescent idiopathic sclerosis (AIS). However, there are few reports of the perforation rate when using O-arm navigation to insert pedicle screws for AIS. To our knowledge, no information has been published regarding risk factors for pedicle perforation by PS when using O-arm navigation during surgery for AIS.
METHODS
We retrospectively reviewed the cases of 23 consecutive patients with AIS (all female; mean age 15.4 years, range 12-19 years) who had all undergone PS fixation under O-arm navigation.
RESULTS
There were 11 major pedicle perforations (Grade 2 or 3) by the 404 screws (2.7%). For both Grade 1 to 3 and Grade 2 or 3 perforations, the pedicle perforation rate by the ninth or subsequent screws was significantly higher than that for the other two groups (screws 1-4, 5-8) (P < 0.01). Grade 1 to 3, Grades 2 or 3, and Grade 3 perforation rates after a previous perforation were significantly higher than those in patients without a previous perforation (P < 0.01). The rate of screw deviation can increase significantly to 12.2% after insertion of 8.
CONCLUSION
The rate of major perforation of pedicles after inserting PS using O-arm navigation during surgery for AIS is relatively low. However, we recommend caution using intraoperative navigation after inserting eight pedicle screws because after this, the trajectory deviation rate can increase significantly.
LEVEL OF EVIDENCE
研究设计
观察性队列研究。
目的
本研究旨在比较使用 O 臂导航在脊柱侧凸手术中插入螺钉（PS）时的椎弓根穿孔率，并确定与 O 臂导航相关的特定危险因素。
背景数据概要
O 臂导航提供了与 CT 图像质量相似的术中三维透视成像。外科医生已开始将 O 臂导航用于治疗青少年特发性脊柱侧凸（AIS）。然而，关于使用 O 臂导航插入 AIS 椎弓根螺钉时的穿孔率报告较少。据我们所知，关于在 AIS 手术中使用 O 臂导航时 PS 插入椎弓根穿孔的危险因素，尚无任何信息公布。
方法
我们回顾性分析了 23 例连续 AIS 患者（均为女性；平均年龄 15.4 岁，范围 12-19 岁）的病例，所有患者均在 O 臂导航下进行 PS 固定。
结果
404 枚螺钉中有 11 枚出现严重椎弓根穿孔（2.7%）。对于 1 级至 3 级和 2 级或 3 级穿孔，第 9 枚或后续螺钉的穿孔率明显高于其他两组（螺钉 1-4、5-8）（P < 0.01）。在前次穿孔后出现 1 级至 3 级、2 级或 3 级和 3 级穿孔的发生率明显高于无既往穿孔的患者（P < 0.01）。插入 8 个螺钉后，螺钉偏差率可显著增加至 12.2%。
结论
在 AIS 手术中使用 O 臂导航插入 PS 后椎弓根主要穿孔率相对较低。然而，我们建议在插入 8 个椎弓根螺钉后谨慎使用术中导航，因为在此之后，轨道偏差率会显著增加。
证据水平
3 级。
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