一种用于创伤性胸腰椎骨折经皮椎弓根螺钉固定的实时三维电磁导航系统：与传统透视引导相比，在效率、透视时间及准确性方面的意义

A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance.

作者信息

Yao Yawei, Jiang Xiang, Wei Tanjun, Yao Zhipeng, Wu Boyu, Xu Feng, Xiong Chengjie

机构信息

The First School of Clinical Medicine, Southern Medical University, 1023-1063, South Shatai Road, Baiyun District, Guangzhou, 51000, China.

Orthopaedic Department, General Hospital of Central Theater Command of PLA, 627 Wuluo Road, Wuchang District, Wuhan, 43007, China.

出版信息

Eur Spine J. 2022 Jan;31(1):46-55. doi: 10.1007/s00586-021-06948-4. Epub 2021 Jul 31.

DOI:10.1007/s00586-021-06948-4

PMID:34333714

Abstract

PURPOSE

Navigation is becoming more useful in percutaneous pedicle screw fixation (PPSF). The aim of this study was to compare the efficiency, fluoroscopic time, accuracy, and clinical outcomes of PPSF with a novel electromagnetic navigation (EMN) system for thoraco-lumbar (TL) fractures with those of PPSF with conventional C-arm fluoroscopic (CF) guidance.

METHODS

A retrospective study was conducted. A total of 162 screws were implanted in 29 patients with the assistance of the EMN system (EMN group), and 220 screws were inserted in 40 patients by using CF guidance (CF group). The duration of surgery, placement time per screw, fluoroscopic time per screw, accuracy of pedicle screw placement, and clinical outcomes were compared between the two groups.

RESULTS

The duration of surgery and placement time per screw in the EMN group were significantly lower than those in the CF group (P < 0.05). The fluoroscopic time per screw in the CF group was significantly longer than that in the EMN group (P < 0.05). The learning curve of PPSF in the EMN group was steeper than that in the CF group. The accuracy of pedicle screw placement in the EMN group was more precise than that in the CF group (P < 0.05). The VAS scores in the EMN group were significantly lower than those in the CF group at one-week postoperatively (P < 0.05).

CONCLUSION

Compared with PPSF by using conventional fluoroscopic guidance, PPSF with the aid of the EMN system can increase the efficiency and accuracy of pedicle screw placement and reduce the fluoroscopic time.

摘要

目的

导航在经皮椎弓根螺钉固定术（PPSF）中变得越来越有用。本研究的目的是比较新型电磁导航（EMN）系统用于胸腰椎（TL）骨折的PPSF与传统C型臂荧光透视（CF）引导下的PPSF在效率、透视时间、准确性和临床结果方面的差异。

方法

进行一项回顾性研究。在EMN系统辅助下，29例患者共植入162枚螺钉（EMN组），40例患者通过CF引导插入220枚螺钉（CF组）。比较两组的手术时间、每枚螺钉的置入时间、每枚螺钉的透视时间、椎弓根螺钉置入的准确性和临床结果。

结果

EMN组的手术时间和每枚螺钉的置入时间显著低于CF组（P < 0.05）。CF组每枚螺钉的透视时间显著长于EMN组（P < 0.05）。EMN组PPSF的学习曲线比CF组更陡。EMN组椎弓根螺钉置入的准确性高于CF组（P < 0.05）。术后1周，EMN组的视觉模拟评分（VAS）显著低于CF组（P < 0.05）。