Wang Lihang, Tang Qian, Chen Qiling, Lu Tingsheng, Yao Shudan, Pu Xingwei, Ji Linsong, Luo Chunshan
Department of Spine Surgery, Beijing Jishuitan Hospital Guizhou Hospital/Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550004, P. R. China.
Department of Burn and Plastic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang Guizhou, 550004, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jun 15;37(6):700-705. doi: 10.7507/1002-1892.202302089.
To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery.
Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( >0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated.
Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( >0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( <0.05). There was no complications related to screws implantation during or after operation in the two groups.
The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
探讨一种新型点接触椎弓根导航模板（为简便起见简称为“新导航模板”）在脊柱侧弯矫正手术中辅助螺钉植入的有效性。
选取2020年2月至2023年2月期间符合入选标准的25例脊柱侧弯患者作为试验组。在脊柱侧弯矫正手术中，使用三维打印的新导航模板辅助螺钉植入。根据纳入和排除标准，将2019年2月至2023年2月期间采用传统徒手植入技术进行螺钉植入的50例患者作为对照组进行匹配。两组在性别、年龄、病程、主弯冠状面Cobb角、主弯弯曲位Cobb角、主弯顶椎位置、椎弓根直径低于全国平均水平50%/75%的椎体数量以及顶椎旋转超过40°的患者数量方面无显著差异（>0.05）。比较两组的融合椎体数量、椎弓根螺钉数量、椎弓根螺钉植入时间、植入出血、透视频率和手动复位频率。观察植入并发症的发生情况。根据术后2周的X线片记录椎弓根螺钉分级，计算植入准确性和主弯矫正率。
两组均成功完成手术。其中，试验组植入螺钉267枚，融合椎体177个；对照组植入螺钉523枚，融合椎体358个。两组在融合椎体数量、椎弓根螺钉数量、椎弓根螺钉分级及准确性、主弯矫正率方面无显著差异（>0.05）。然而，试验组的椎弓根螺钉植入时间、植入出血、透视频率和手动复位频率均显著低于对照组（<0.05）。两组在手术期间及术后均未发生与螺钉植入相关的并发症。
新导航模板适用于各种变形的椎板和关节突，不仅提高了螺钉植入的准确性，还降低了手术难度，缩短了手术时间，减少了术中出血。
