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背景:O型臂导航系统是目前最先进的导航技术,可短时间内获得较高质量的术中三维CT图像,但其应用于脊柱外科时间尚短,应用价值需要进一步研究。目的:初步探讨O型臂导航系统在青少年特发性脊柱侧凸矫形内固定术中的应用价值。方法:回顾性分析2013年1月至2014年12月行脊柱后路侧凸矫形内固定术的青少年特发性脊柱侧凸患者42例,男7例,女35例。其中术中应用O型臂导航指导螺钉植入19例为O型臂导航组,依靠C型臂X线机透视和术者经验植入螺钉23例为C型臂引导组。分别记录两组患者的手术时间、置钉时间、术中出血量以及并发症发生情况;通过CT扫描对椎弓根螺钉位置进行分级,采用Richter方法计算两组的置钉优良率,术后通过全脊柱正侧位X线片评价矫形效果。结果:42例患者均顺利完成手术,两组患者的性别、年龄、累及节段、术前Cobb角等一般资料无统计学差异(P>0.05)。O型臂导航组患者上胸椎(T1~T4)、中胸椎(T5~T8)的置钉优良率为94.4%和95.6%,与C型臂引导组的78.9%和85.4%相比有统计学差异(P<0.05)。O型臂导航组下胸椎(T9~T12)以及腰椎(L1~L5)的置钉优良率为94.7%和95.4%,略高于C型臂引导组的88.2%和92.1%,相比无统计学差异(P>0.05)。O型臂导航组患者置钉时间为(75±20)min,显著低于C型臂引导组的(93±18)min(P<0.05)。两组手术时间、术中出血量比较无统计学差异(P>0.05)。所有患者均获得12~19个月,平均(16.5±2.1)个月的随访。两组术后1周及末次随访时主弯Cobb角均较术前显著改善(P<0.05);术后1周与末次随访比较无统计学差异(P>0.05)。两组患者末次随访时Cobb角矫正率比较无统计学差异(P>0.05)。结论:O型臂导航技术应用于青少年特发性脊柱侧凸的手术治疗中可提高胸腰椎椎弓根螺钉植入的准确性和安全性,及时发现危险螺钉并重置,保障手术安全,近期矫形疗效确切。
Background: The O-arm navigation system is the most advanced navigation technology at present and can obtain high quality intraoperative CT images in a short period of time. However, its application to spine surgery is still short and its application value needs further study. Objective: To explore the value of O-arm navigation system in orthopedic adolescent idiopathic scoliosis. Methods: A retrospective analysis of 42 cases of adolescent idiopathic scoliosis with posterior scoliosis orthopedic fixation from January 2013 to December 2014 was performed, including 7 males and 35 females. Among them, 19 cases of O-arm navigation group were implanted with O-arm navigation guidance screws and 23 cases of C-arm guidance group by C-arm X-ray machine and experience of surgeons. The operation time, nailing time, intraoperative blood loss and complication were recorded respectively. The position of pedicle screw was graded by CT scanning. The excellent and excellent rate of pedicle screw fixation was calculated by Richter method and postoperatively Full spine is lateral radiograph evaluation of orthopedic effect. Results: All the 42 patients completed the operation smoothly. There was no significant difference in the gender, age, involved segments and preoperative Cobb angle between the two groups (P> 0.05). In the O-arm navigation group, the excellent and good rates of pedicle screw fixation on upper thoracic vertebrae (T1 ~ T4) and mid thoracic vertebrae (T5 ~ T8) were 94.4% and 95.6%, respectively, as compared with 78.9% and 85.4% in C-arm guidance group Difference (P <0.05). The excellent and good rates of placement of lower thoracic vertebra (T9 ~ T12) and lumbar vertebrae (L1 ~ L5) in O-arm navigation group were 94.7% and 95.4%, respectively, slightly higher than 88.2% and 92.1% in C-arm guidance group Learning difference (P> 0.05). The nail placement time in O-arm navigation group was (75 ± 20) min, which was significantly lower than that in C-arm guidance group (93 ± 18) min (P <0.05). There was no significant difference in operative time and blood loss between the two groups (P> 0.05). All patients were 12 to 19 months, with an average of (16.5 ± 2.1) months of follow-up. The Cobb angle of primary curve at 1 week after operation and the last follow-up were significantly improved in both groups (P <0.05). There was no significant difference between the last follow-up and the 1 week after operation (P> 0.05). There was no significant difference in Cobb angle between the two groups at the last follow-up (P> 0.05). Conclusion: The application of O-arm navigation technique in the surgical treatment of adolescent idiopathic scoliosis can improve the accuracy and safety of pedicle screw fixation in thoracolumbar spine. The detection of dangerous screw in time and reset, to ensure the safety of surgery, the recent Orthopedic effect is exact.