Lin Xuxin, Shang Lijie, Shen Suhong, Wang Qingfeng, Fu Xiaoyan, Zhao Gang
Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China.
First Department of Minimally Invasive Spine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Oct 15;37(10):1253-1258. doi: 10.7507/1002-1892.202306071.
To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study.
Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T in 15 cases, L in 20 cases, L in 19 cases, and L in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded.
In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( <0.05).
UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
通过前瞻性随机对照研究，探讨超声容积导航（UVN）联合X线透视引导下经皮椎弓根螺钉植入术的可行性和准确性。
纳入2022年1月至2023年1月计划行经皮椎弓根螺钉固定术的胸腰椎骨折患者。其中，60例患者符合入选标准并纳入研究。男性28例，女性32例，平均年龄49.5岁（范围29 - 60岁）。受伤原因包括交通事故20例、跌倒21例、滑倒17例、重物撞击2例。受伤至入院间隔时间为1至5天（平均1.57天）。骨折位于T 15例，L 20例，L 19例，L 6例。本研究以每位患者自身作为对照，随机在椎体一侧及相邻节段采用UVN联合X线透视引导椎弓根螺钉植入（试验组），另一侧在X线透视引导下植入（对照组）。每位患者共植入4枚螺钉和2根棒。记录每枚螺钉植入时间、植入过程中的透视次数、影像学检查实际与术前计划轨迹的角度偏差和距离偏差以及关节突关节侵犯的发生情况。
在螺钉植入时间、透视次数、角度偏差、距离偏差及关节突关节侵犯发生率方面，试验组结果优于对照组，差异有统计学意义（<0.05）。
UVN联合X线透视引导下经皮椎弓根螺钉植入术可减少螺钉植入时间，动态调整，降低操作难度，减少辐射损伤。
