摘要
目的：探讨导航辅助腰椎椎弓根螺钉置入的准确性和误差产生的原因。方法：16例腰椎疾病的患者，在导航辅助下置入76枚椎弓根螺钉，手术后行x线和CT检查，在矢状位测量螺钉与椎弓根上缘的相对位置、与椎体上缘的角度；横断位测量螺钉与椎弓根内壁的相对位置、与椎体中线的角度。并与手术导航图像的对应数值进行统计学比较。结果：有2枚螺钉偏头侧出椎弓根，术中纠正，1枚螺钉造成椎弓根外壁缺损而被取出，2枚螺钉偏外侧出椎弓根。其余螺钉手术后CT与手术中导航图像显示的位置角度比较没有显著性差异。导航可能产生两种偏差，一种是因为椎体之间的距离缩短，常见于腰椎骨折和腰椎不稳定的患者，手术过程中腰椎前凸加大，螺钉出椎弓根上缘或下缘；另一种是扩椎弓根时图像晃动，或者开路锥在椎弓根内调整位置时产生的虚假图像误导手术者判断错误。结论：在使用导航过程中要采取措施避免腰椎的前凸加大，根据静止的图像做出判断，以减小误差。
Objective：To discuss the accuracy of computer-assisted pedicle screw installation in the lumbar spine and the reason of screw malposition.Method：16 patients who underwent lumbar pedicle screw fixation owing to fracture,spondylolisthesis,and spinal stenosis.76 screws were installed.Screw position and direction were measured on the sagittal and transection image of intraoperative navigation and post-operative CT.The result was analyzed statistically.Result：2 screws perforated the pedicle upper wall ,and were corrected intraop eratively.One destroyed the lateral wall of pedicle and was taken off.2 deviated lateral pedicular wall.There was no difference statistically on the screw position and direction between navigation and CT image.Two kinds of error may occur during navigation operation.One result from the displacement among the vertebrae.lt often occured in lumbar fracture or instability ,in these cases ,lumbar lordosis may increase during operation,disloca tions between the acquisition of navigation and operation lead to misguidance.Screw might perforate the pedicle upper or lower wall.The other result from the image shaking or direction changing of the awl during preparation of the screw hole,operator made wrong decision according to the shaking image.Conclusion：Some methods should be taken to avoid the increase of lumbar lordosis during navigation：decision should be made according to the still image to avoid bias.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2005年第12期736-739,共4页
Chinese Journal of Spine and Spinal Cord
关键词
手术导航
椎弓根螺钉
腰椎
Navigation operation
Pedicle screw
Lumbar spine
