术中CT导航和单纯术中CT扫描辅助下颈椎椎弓根螺钉内固定技术的对比研究

目的探讨使用术中CT导航和单纯术中CT扫描辅助下进行下颈椎椎弓根螺钉内固定的临床效果。方法总结诊断为颈椎病、颈椎外伤、颈椎肿瘤而行CT辅助颈椎椎弓根螺钉内固定的65例老年患者的临床资料。根据术中是否采用CT导航将患者分为术中CT导航组和术中非CT导航组。术后进行经椎弓根螺钉水平的CT平扫,观察椎弓根螺钉置入的精确性。对2组椎弓根螺钉置钉的准确率、翻修率、置钉时间和术中CT的扫描数据进行比较。结果术中CT导航组椎弓根螺钉的穿破率和平均置钉时间显著低于非CT导航组（P〈0.05或P〈0.01）。2组病例均未出现明显的神经、血管损伤并发症。在2组中均没有因内置物位置不佳而行二次手术的病例。结论术中CT导航系统辅助进行颈椎椎弓根螺钉内固定是可行的,能够显著提高后路颈椎椎弓根螺钉置钉的精确性,同时医护人员无X射线暴露。

Comparison of the effects of intraoperative CT navigation and simple intraoperative CT scans on subaxial cervical spine pedicle screw internal fixation

Objective To investigate the effects of intraoperative CT navigation and simple intraoperative CT scans auxiliary on subaxial cervical pedicle screws internal fixation in the elderly patients. Methods The clinical data of 65 elderly patients with cervical spondylosis, cervical spine trauma or tumor who received subaxial cervical pedicle screws internal fixation were retrospectively reviewed. The patients were divided into intraoperative CT navigation group （ 15 cases ） and intraoperative CT non-navigation group（ 50 cases）. CT scan was performed to judge the accuracy of pedicle screw placement after operation. The accuracy rate of placement, the repairing rate, mean placement time per screw and the intraoperative CT scan data were analyzed and compared between the two groups. Results The cervical screw spikes worn out rate and mean placement time per screw were significantly lower in CT navigation group than those in non-navigation group （P〈 0.05 or P〈0.01 ）. There were no patients suffering from nerve and vascular complications. None of them received another operation in the two groups. Conclusions Intraoperative CT aided navigation system for cervical pedicle screw fixation is feasible, and can significantly improve the accuracy of the posterior cervical spine pedicle screws, and no medical staffs expose to X ray.