Department of Spine Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China.
Orthop Surg. 2024 Dec;16(12):2976-2983. doi: 10.1111/os.14231. Epub 2024 Sep 10.
Imperfect fitting of the navigation template leads to prolonged surgery time and increased blood loss. These problems have not been effectively addressed in previous research. This study explores the efficacy of a novel 5-point positioning point-contact pedicle navigation template in complex pedicle situations in scoliosis.
This study employed a retrospective controlled design. From November 2019 to November 2023, 28 patients with scoliosis and complex pedicle were selected and underwent scoliosis correction surgery. A 5-point positioning point-contact pedicle navigation template was used intraoperatively to guide pedicle screw placement. Matched with 56 historical cases as a control group. The analysis included screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual repositioning frequency, screw placement accuracy and grade, screw placement complications, and main curve correction rate. Continuous variables were compared using the independent samples t-test. Categorical data were analyzed with the chi-square test.
All 28 patients successfully underwent surgery, with a total of 268 pedicle screws placed. The surgery duration ranged from 220 to 410 min, with an average of (283.16 ± 51.26) min. Intraoperative blood loss ranged from 630 to 1900 mL, with an average of (902.17 ± 361.25) mL. Pedicle screw placement time ranged from 60 to 130 min, with an average of (85.24 ± 24.65) min. Pedicle screw placement bleeding volume ranged from 40 to 180 mL, with an average of (76.47 ± 42.65) mL. Fluoroscopy frequency ranged from 3 to 7 times, with an average of (4.31 ± 1.14) times. Manual repositioning frequency ranged from 0 to 2 times, with an average of (0.46 ± 0.58) times. Pedicle screw placement grades: Grade I: 237 screws; Grade II: 25 screws; Grade III: 6 screws; Grade IV: 0 screws. There were no screw-related complications. The correction rate ranged from 46% to 68%, with an average of (55.83 ± 9.22)%. Compared to the experienced screw group, the differences in screw placement time, screw placement bleeding volume, fluoroscopy procedures, and manual redirections were statistically significant (p < 0.05).
The 5-point positioning point-contact pedicle navigation template features a claw-like structure that securely adapts to various deformed vertebral facet joints, avoiding drift phenomena and ensuring accurate screw placement. Its pointed contact structure with the lamina of the spine avoids extensive and complete detachment of posterior structures, reducing blood loss, surgery time, and trauma. Predesigned pedicle screw entry points and directions reduce fluoroscopy frequency and surgery time.
导航模板拟合不完美会导致手术时间延长和出血量增加。这些问题在之前的研究中尚未得到有效解决。本研究探讨了一种新型 5 点定位点接触椎弓根导航模板在脊柱侧凸复杂椎弓根情况下的疗效。
本研究采用回顾性对照设计。2019 年 11 月至 2023 年 11 月，选择 28 例脊柱侧凸伴复杂椎弓根的患者行脊柱侧凸矫形手术。术中采用 5 点定位点接触椎弓根导航模板引导椎弓根螺钉置入。与 56 例历史病例作为对照组相匹配。分析包括螺钉放置时间、螺钉放置出血量、透视次数、手动复位次数、螺钉放置准确性和等级、螺钉放置并发症以及主弯矫正率。连续变量采用独立样本 t 检验进行比较。分类数据采用卡方检验进行分析。
28 例患者均顺利完成手术，共置入 268 枚椎弓根螺钉。手术时间为 220-410 分钟，平均（283.16±51.26）分钟。术中出血量为 630-1900 毫升，平均（902.17±361.25）毫升。椎弓根螺钉放置时间为 60-130 分钟，平均（85.24±24.65）分钟。椎弓根螺钉放置出血量为 40-180 毫升，平均（76.47±42.65）毫升。透视次数为 3-7 次，平均（4.31±1.14）次。手动复位次数为 0-2 次，平均（0.46±0.58）次。椎弓根螺钉放置等级：Ⅰ级：237 枚螺钉；Ⅱ级：25 枚螺钉；Ⅲ级：6 枚螺钉；Ⅳ级：0 枚螺钉。无螺钉相关并发症。矫正率为 46%-68%，平均（55.83±9.22）%。与经验丰富的螺钉组相比，螺钉放置时间、螺钉放置出血量、透视次数和手动复位的差异有统计学意义（p<0.05）。
5 点定位点接触椎弓根导航模板具有爪状结构，可牢固适应各种变形的关节突关节，避免漂移现象，确保螺钉准确放置。其与脊柱椎板的点状接触结构避免了广泛而完整地分离后部结构，减少了出血量、手术时间和创伤。预设的椎弓根螺钉进钉点和方向减少了透视次数和手术时间。
