Jing Linkai, Wang Zhenze, Sun Zhenxing, Zhang Huifang, Wang James, Wang Guihuai
School of Clinical Medicine, Tsinghua University, Beijing, 100084 China.
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218 China.
Chin Neurosurg J. 2019 Mar 4;5:6. doi: 10.1186/s41016-019-0154-y. eCollection 2019.
The accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade. This study aimed to evaluate the accuracy of pedicle screw placement using O-arm-based navigation system versus conventional freehand technique.
We reviewed the accuracy of 341 thoracic ( = 173) and lumbosacral ( = 168) pedicle screws placed in 60 consecutive patients using either O-arm-based navigation or freehand technique in the Department of Neurosurgery of Beijing Tsinghua Changgung Hospital between January 2015 and June 2018. Patient-specific characteristics, treatment-related characteristics, and screw-specific accuracy were analyzed. The accuracy of pedicle screw placement was measured by Gertzbein-Robbins scale and screw grades A and B were clinically acceptable.
One hundred ninety-one screws were inserted in the O-arm-based navigation group and 150 in the freehand group. One hundred eighty-three (95.81%) clinically acceptable screws were placed in the navigation group and 135 (90.00%) in the freehand group ( = 0.034). Twenty-three (6.74%) screw revisions were performed in the two groups (8 screws in the navigation group and 15 screws in the freehand group) and significant difference was observed in thoracic spine ( = 0.018), while no statistical significance was presented in lumbosacral spine ( > 0.05). Twenty-four (12.57%) screws in the navigation group and 24 (16.00%) in the freehand group violated the cortex ( > 0.05). Medial screw deviation was the most common problem in the two groups.
The O-arm-based navigation exhibits higher accuracy for pedicle screw insertion than the freehand insertion technique.
在过去十年中，术中三维导航系统的引入显著提高了椎弓根螺钉置入的准确性和安全性。本研究旨在评估基于O型臂的导航系统与传统徒手技术在椎弓根螺钉置入方面的准确性。
我们回顾了2015年1月至2018年6月期间在北京清华长庚医院神经外科连续60例患者中使用基于O型臂的导航或徒手技术置入的341枚胸椎（n = 173）和腰骶椎（n = 168）椎弓根螺钉的准确性。分析了患者特异性特征、治疗相关特征和螺钉特异性准确性。椎弓根螺钉置入的准确性通过Gertzbein-Robbins量表测量，临床可接受的螺钉等级为A和B。
基于O型臂的导航组置入191枚螺钉，徒手组置入150枚螺钉。导航组置入183枚（95.81%）临床可接受的螺钉，徒手组置入135枚（90.00%）（P = 0.034）。两组共进行了23次（6.74%）螺钉翻修（导航组8枚，徒手组15枚），在胸椎中观察到显著差异（P = 0.018），而在腰骶椎中无统计学意义（P > 0.05）。导航组24枚（12.57%）螺钉和徒手组24枚（16.00%）螺钉穿破皮质（P > 0.05）。两组中最常见的问题是螺钉向内侧偏移。
基于O型臂的导航在椎弓根螺钉置入方面比徒手置入技术具有更高的准确性。
