摘要
目的比较等中心C型臂（Iso-C）三维导航与普通透视下辅助下置人寰椎侧块和枢椎椎弓根（C1LM-C2P）螺钉的准确性。方法对2006年6月至2011年6月采用C1LM-C2P螺钉内固定治疗的30例寰枢椎小稳患者资料进行回顾性研究，男16例，女14例；年龄39～52岁，平均45．6岁、，根据术中辅助影像技术的不同分为Iso-C三维导航组（导航组，14例）和普通透视组（透视组，16例）。两组患者术前一般资料比较差肆均无统计学意义（P〉0．05），具有可比性。记录并比较两组患者的于术时间、透视时间、术中失血量、置钉准确率和日本骨科协会评分（JOA）。结果导航组和透视组置人C1LM-C2P螺钉的平均手术时间分别为（132．1±6．4）min和（143．2±8．2）min，差异尤统计学意义（仁1．761．P=0．093）。导航组术中平均透视时间（46．84±1．4）s较透视组（65．24±2．9）s明显减少，导航组平均术中失血量（305．64±50．8）mL较透视组（472．4±56．1）mL明显减少，导航组和透视组分别有94．6％和82．8％的螺钉评为0级，以上指标两组比较差异均有统计学意义（P〈0．05）。所有患者术后平均随访12．4个月，术后6个月颈椎X线片示骨折愈合。术后6个月导航组和透视组平均JOA评分分别为（15．2±0．2）分和（15．3±0．3）分，差异无统计学意义（P=0．756）；但较术前[（9．1±1．1）分]明显改善，差异均有统计学意义（P〈0．05）。结论采用ClLM-C2P螺钉治疗寰枢椎不稳时，术中采用Iso-C三维导航比普通透视能显著提高螺钉置人的准确性，并能显著减少术中透视时间及术中出血量。
Objective To compare the isocentric C-arm 3-dimensional （lso-C 3D） navigation versus conventional C-arm fluoroscopy in terms of accuracy of placing CI lateral mass and C2 pedicle （C1LM-C2P） screws in the treatment of atlantoaxial instability. Methods Thirty patients with atlantoaxial instability were treated with fixation with CI I,M-C2P screws in our hospital from June 2006 to June 201 I. They were 16 men and 14 women, aged frnm 39 to 52 years （average, 45.6 years）. The Iso-C 3D navigation group had 14 patients and there were 16 patients in the conventional fluoroscopy group. The 2 groups were comparable in general clinical data （ P 〉 0.05） . The operation time, radiation time, intraoperative blood loss, insertion accuracy and Japanese Orthopaedic Association （JOA） score were recorded and compared between the 2 groups. Results There were no significant differences between the 2 groups in the mean operation time （132. 1 ±6.4 minutes versus 143.2 ±8.2 minutes） （ t = 1. 761, P =0. 093） . The mean radiation time for the lso-C 3D navigation group （46.8 ± 1.4 seconds） was significantly shorter than for the conventional fluo- roscopy group （65.2±2.9 seeomts）, the mean blood loss for the navigation group （305.6 ±50.8 mL） was significantly less than for the fluoroscopy group （472.4± 56. 1 mL）, the percentage of screws of grade 0 forthe navigation group （94. 6% ） was significantly higher than for the fluoroscopy group （82.8%） （ P 〈 0. 05 ） . The mean follow-up of 12.4 months revealed fracture union on cervical X-ray films 6 months post- operation. There were no significant differences between the 2 groups in the mean JOA score 6 months post- operation （15.2± 0. 2 points versus 15.3 ± 0. 3 points）, but there were significant differences between the preoperative and postoperative scores in the 2 groups （ P 〈 0.05）. Conclusion In the treatment of at- lantoaxial instability with fixation with C1LM-C2P screws, compared with conventional C-ann fluoroscopy, Iso-C 3D navigation can significantly improve the accuracy of screw placement and reduce intraoperative flu- oroscopic time and blood loss.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第12期1059-1064,共6页
Chinese Journal of Orthopaedic Trauma
基金
山东省医药卫生科技发展计划（2009年第HZ062号）
