Yamada Tomohiro, Yamato Yu, Hasegawa Tomohiko, Yoshida Go, Banno Tomohiro, Arima Hideyuki, Oe Shin, Ide Koichiro, Kurosu Kenta, Matsuyama Yukihiro
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu 431-3125, Japan.
J Clin Med. 2025 Jul 3;14(13):4729. doi: 10.3390/jcm14134729.
The aim of this study was to assess pedicle screw (PS) accuracy and identify perforation patterns using computed tomography (CT) navigation in adolescent idiopathic scoliosis (AIS) surgery. A total of 107 AIS patients were retrospectively reviewed. Preoperative CT navigation was used in 48 patients (853 screws), and intraoperative CT with a second 3D scan was used in 59 patients (1059 screws). Postoperative CT images were analyzed using the Rampersaud grading system. Overall PS accuracy (grade A + B) was significantly higher in the intraoperative CT group than the preoperative group (97% vs. 95%, = 0.008). In Lenke type 1 cases, accuracy was also higher in the intraoperative group (97.8% vs. 95.1%, = 0.014). Grade D perforations were most frequent on the concave side of the proximal thoracic (PT) zone in both groups. Ten screws were re-inserted during surgery in the intraoperative group based on findings from the second 3D scan. The concave PT zone is a common site for PS misplacement. Intraoperative CT navigation with a second 3D scan enhances PS accuracy compared with preoperative CT navigation.
本研究的目的是评估青少年特发性脊柱侧凸（AIS）手术中使用计算机断层扫描（CT）导航时椎弓根螺钉（PS）的准确性，并识别穿孔模式。对107例AIS患者进行了回顾性研究。48例患者（853枚螺钉）采用术前CT导航，59例患者（1059枚螺钉）采用术中CT及第二次三维扫描。使用兰珀绍德分级系统分析术后CT图像。术中CT组的总体PS准确性（A级+B级）显著高于术前组（97%对95%，P = 0.008）。在Lenke 1型病例中，术中组的准确性也更高（97.8%对95.1%，P = 0.014）。两组中D级穿孔在近端胸椎（PT）区的凹侧最为常见。术中组根据第二次三维扫描的结果在手术中重新植入了10枚螺钉。凹侧PT区是PS误置的常见部位。与术前CT导航相比，术中CT导航及第二次三维扫描可提高PS的准确性。
