摘要
背景:椎弓根螺钉目前广泛应用于脊柱外科临床,其精准置入为关注焦点。此次研究探寻了一种新的椎弓根螺钉置入方法,以期提高临床置钉的准确率。目的:观察应用自主研制的角度控制椎弓根螺钉置入工具结合3D模型及导板在辅助椎弓根螺钉置入中的应用价值。方法:选择2023年3月至2024年6月接受椎弓根螺钉内固定治疗的患者共计96例,随机分成2组,辅助组和徒手组各48例。辅助组使用角度控制椎弓根螺钉置入工具配合3D模型和导板辅助螺钉置入,徒手组则依赖C型臂X射线机进行定位,徒手置入螺钉。所有患者均进行CT检查以评估两种方式下单枚螺钉置入时间及精确度,另外对比C型臂X射线机使用频率。结果与结论:①辅助组共置入286枚螺钉,置钉用时(2.51±1.26)min/枚,精确置入成功率达到95.8%,C型臂透视次数为(1.45±2.12)次/枚;徒手组共置入螺钉264枚,置入用时为(3.27±1.54)min/枚,精确置入成功率为87.2%,C型臂透视次数是(2.19±1.73)次/枚;②相较而言,辅助组在这3个指标上均表现出显著优势:单枚螺钉置入时间更短,置钉准确率更高,且C型臂透视次数也相对较低,与徒手组相比差异有显著性意义(P<0.05);③提示在实施脊柱椎弓根钉置入时,利用角度控制的椎弓根螺钉置入工具配合3D模型和导板能有效提升置钉的精确度,降低所需时间,并且减少辐射暴露的风险,这无疑具备极高的临床实用意义。
BACKGROUND:Pedicle screws are widely used in spine surgery,and their precise placement is the focus of attention.In this study,a new pedicle screw placement method was explored to improve the accuracy of clinical nail placement.OBJECTIVE:To observe the application value of the self-developed angle control pedicle screw implantation tool combined with 3D model and guide plate in auxiliary pedicle screw implantation.METHODS:Totally 96 patients with spinal surgery who received pedicle screw internal fixation from March 2023 to June 2024 were selected and divided into two groups by random sampling method,namely the assisted group and the freehand group,with 48 patients in each group.The assisted group used an anglecontrolled pedicle screw implantation tool with 3D model and guide plate to assist screw implantation,while the freehand group relied on C-arm X-ray machine for positioning and freehand screw implantation.All patients underwent CT examination to evaluate the differences in the time,accuracy,and frequency of C-arm X-ray machine use between the two methods.RESULTS AND CONCLUSION:(1)A total of 286 screws were implanted in the assisted group,with an implantation time of(2.51±1.26)min/screw and an accurate implantation success rate of 95.8%,while(1.45±2.12)times/screw were required by using C-arm fluoroscopy equipment;264 screws were implanted in the freehand group,with an implantation time of(3.27±1.54)min/screw,an accurate implantation success rate of 87.2%,and the number of C-arm fluoroscopy was(2.19±1.73)times/screw.(2)In comparison,the assisted group showed significant advantages in these three indicators:shorter single screw implantation time,higher screw placement accuracy,and lower C-arm fluoroscopy times,which were significantly different from those in the freehand group(P<0.05).(3)It is concluded that the use of angle-controlled pedicle screw implantation tools,combined with 3D model and guide plate assist,in pedicle screw implantation surgery can significantly enhance accuracy,shorten the time needed for placement,as well as reduce radiation exposure,all of which have clinical applications.
作者
杨镇源
张继伟
张凯东
马冰清
张彦军
李军杰
Yang Zhenyuan;Zhang Jiwei;Zhang Kaidong;Ma Bingqing;Zhang Yanjun;Li Junjie(Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,Gansu Province,China;Lanzhou Orthopedic Hospital,Lanzhou 730030,Gansu Province,China)
出处
《中国组织工程研究》
北大核心
2026年第15期3906-3912,共7页
Chinese Journal of Tissue Engineering Research
基金
兰州市科技计划项目(2019-ZD-119),项目负责人:杨镇源。
关键词
椎弓根螺钉
内固定
角度控制
3D模型
导板
置钉
pedicle screw
internal fixation
angle control
3D model
guide plate
nail placement
