術中CT導航在脊柱側凸后路胸椎椎弓根螺釘植入術中的應用_《中國修復重建外科雜志》

作者：

施新革 , 張永剛 , 張雪松 , 崔庚 , 毛克亞 , 王征 , 董天祥 , 王巖

解放軍總醫院骨科（北京，100853）;

關鍵詞：

脊柱側凸后路胸椎椎弓根螺釘植入術術中CT導航

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目的探討術中CT導航在脊柱側凸后路胸椎椎弓根螺釘植入術中的應用價值。方法回顧分析2009年10月－2011年12月行脊柱后路矯形融合術的46例胸彎脊柱側凸患者臨床資料，比較術中CT導航下（A組，21例）和傳統C臂X線機下徒手（B組，25例）植入胸椎椎弓根螺釘的準確性和安全性。兩組患者性別、年齡、脊柱側凸類型、累及節段、主胸彎Cobb角等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。 A、B組各植入胸椎椎弓根螺釘273枚及308枚。采用Modi等方法，通過術中CT掃描對椎弓根螺釘位置分級，計算兩組在上胸椎（T1～4）、中胸椎（T5～8）、下胸椎（T9～12）和整個胸椎（T1～12）的準確植釘率、安全植釘率和潛在危險植釘率。結果 A組整個胸椎的準確植釘率（93.4%）、安全植釘率（98.9%）均顯著高于B組（83.8%、92.5%），潛在危險植釘率（1.1%）顯著低于B組（7.5%），比較差異均有統計學意義（P lt; 0.05）。兩組上、中、下胸椎的準確植釘率、安全植釘率和潛在危險植釘率比較，差異均無統計學意義（P gt; 0.05）。根據CT評估結果將潛在危險植釘重新植釘或去除。術后3 d根據神經系統體檢評定兩組均無神經功能缺失發生。結論與傳統C臂X線機下徒手植釘技術相比，術中CT導航可提高胸椎椎弓根螺釘植入的準確性和安全性，可在術中發現危險螺釘并及時去除或修正，保障手術安全。

引用本文： 施新革,張永剛,張雪松,崔庚,毛克亞,王征,董天祥,王巖. 術中CT導航在脊柱側凸后路胸椎椎弓根螺釘植入術中的應用. 中國修復重建外科雜志, 2012, 26(12): 1415-1419. doi: 復制

1.	15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
2.	18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
3.	24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
4.
5.
6.	Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
7.	Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
8.	Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
9.	Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
10.	Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
11.	Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
12.	Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
13.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
14.	Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
15.	Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
16.	Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
17.	Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
18.	Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
19.	Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
20.	Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
21.	Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
22.	Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
23.	Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
24.	Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
25.	Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
26.	Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.

1. 15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
2. 18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
3. 24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
4.
5.
6. Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
7. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
8. Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
9. Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
10. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
11. Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
12. Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
13. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
14. Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
15. Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
16. Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
17. Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
18. Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
19. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
20. Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
21. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
22. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
23. Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
24. Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
25. Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
26. Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.

《中國修復重建外科雜志》

術中CT導航在脊柱側凸后路胸椎椎弓根螺釘植入術中的應用

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《中國修復重建外科雜志》

術中CT導航在脊柱側凸后路胸椎椎弓根螺釘植入術中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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