| 脊柱侧凸数字导航模板的准确性与安全性的病例对照研究 |
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投稿时间：2015-09-01
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| 作者 | Author | 单位 | Address | E-Mail |
| 张宇鹏 |
ZHANG Yu-peng |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Hospital Affiliated to the General Hospital of PLA, Beijing 100048, China |
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| 史亚民 |
SHI Ya-min |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Hospital Affiliated to the General Hospital of PLA, Beijing 100048, China |
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| 王华东 |
WANG Hua-dong |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Hospital Affiliated to the General Hospital of PLA, Beijing 100048, China |
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| 侯树勋 |
HOU Shu-xun |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Hospital Affiliated to the General Hospital of PLA, Beijing 100048, China |
hnronald@hotmail.com |
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| 期刊信息：《中国骨伤》2015年，第28卷，第10期，第945-950页 |
| DOI：10.3969/j.issn.1003-0034.2015.10.015 |
| 基金项目: |
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中文摘要:
目的:设计新型脊柱侧凸个体化数字导航模板(简称导板)并在手术中应用,评价其置钉准确性和安全性。
方法:2013年12月至2014年12月,对10例脊柱侧凸病例(观察组)进行CT扫描,应用计算机软件进行模型重建、模拟置钉和导板设计;应用快速成型技术制造导板;在手术中应用导板辅助置钉,记录其出血量、手术时间、术前与术后血肌酐含量变化、置钉相关并发症发生情况,术后CT扫描明确螺钉位置并进行分级,评价置钉准确率,并与同期行徒手置钉的10例脊柱侧凸病例(对照组)进行对比。观察组包括特发性侧凸5例,先天性侧凸5例;男3例,女7例;年龄4～18岁,平均11.9岁;主弯Cobb角42.1°～78.4°,平均54.9°。对照组包括特发性侧凸5例,先天性侧凸5例,男2例,女8例;年龄6～17岁,平均12.6岁;主弯Cobb角38.2°～93.4°,平均56.6°。
结果:观察组置钉167枚,其中Ⅰ级138枚(82.6%),Ⅱ级25枚(15.0%),Ⅲ级4枚(2.4%),无Ⅳ级螺钉;穿破皮质29枚(17.4%),可接受螺钉163枚(97.6%).对照组置钉165枚,其中Ⅰ级98枚(59.4%),Ⅱ级39枚(23.6%),Ⅲ级21枚(12.7%),Ⅳ级7枚(4.2%);穿破皮质67枚(40.6%),可接受螺钉137枚(83.0%).两组病例置钉分级、穿破皮质比例、可接受螺钉比例均有差异(Z=-5.013,P=0.000;χ2=9.347,P=0.002;χ2=20.242,P=0.000).Cobb角矫正率[(74.1±10.0)% vs (69.7±17.6)%,出血量(455±447) ml vs (415±389) ml,手术时间 (163.5±53.7) min vs(164.0±48.7) min,术前与术后3 d血Cr变化(-5.3±3.2) vs (-3.4±3.1) μmol/L,差异均无统计学意义(t=0.696,P=0.496;t=0.214,P=0.833;t=0.022,P=0.983;t=1.375,P=0.192).两组均未见与置钉相关的并发症。
结论:应用个体化数字导航模板辅助脊柱侧凸术中椎弓根螺钉置入,准确性较徒手置钉明显提高,且安全性良好。 |
| 【关键词】脊柱侧凸 外科手术,计算机辅助 椎弓根螺钉 病例对照研究 |
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| Case-control study on accuracy and safety of patient-specific drill-guide templates used in scoliosis cases |
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ABSTRACT
Objective:To evaluate the accuracy and safety of pedicle screw insertion with the aid of novel patient-specific drill-guide templates in scoliosis cases.
Methods:Ten patients with scoliosis were selected to participate in the research (the observation group) from December 2013 to December 2014. The data was obtained from CT scanning,and put into the computer to perform reconstruction of spine,simulation of pedicle screw insertion,and design of patient-specific drill-guide templates with software. The templates were made with rapid prototyping technique. After sterilization,the templates were used to aid the pedicle screw insertion intraoperatively. The blood loss,operation duration,change of creatinine level pre-and post-operation,and complications related to pedicle screw insertion were recorded. The location of pedicle screws were graded so as to evaluate the accuracy. A comparative study was then performed with the data of ten scoliosis cases operated with free-hand method during the same period (control group). There were 5 cases of idiopathic scoliosis and 5 cases of congenital scoliosis in the observation group,including 3 males and 7 females. Their average age was 11.9 years old (ranged,4 to 18 years old),and the average Cobb angle of main curve was 54.9°(ranged,42.1°to 78.4°). There were also 5 cases of idiopathic scoliosis and 5 cases of congenital scoliosis in the control group,including 2 males and 8 females. Their average age was 12.6 years old(ranged,6 to 17 years old),and the average Cobb angle of main curve was 56.6°(ranged,38.2°to 93.4°).
Results:A total of 167 pedicle screws were inserted intraoperatively,with 138 screws (82.6%) in gradeⅠ,26 screws (15.0%) in gradeⅡ,4 screws in grade Ⅲ(2.4%),but no screws in grade Ⅳ according to the CT image. There were 29(17.4%) screws perforated,and 163(97.6%) screws could be accepted. In the control group,a total of 165 pedicle screws were inserted intraoperatively,with 98 screws(59.4%) in grade I,39 screws (23.6%) in gradeⅡ,21 screws in grade Ⅲ(12.7%),and 7 screws in grade Ⅳ (4.2%). There were 67(40.6%) screws perforated,and 137(83.0%) screws could be accepted. The grade distribution of screw position,ratio of perforated and accepted screws were significantly different between the two groups respectively(Z=-5.013,P=0.000;χ2=9.347,P=0.002;χ2=20.242,P=0.000). The correction rate of Cobb angle were (74.1±10.0) % vs (69.7±17.6)%;blood loss were (455±447) ml vs (415±389)ml;operation duration were (163.5±53.7) min vs (164.0±48.7) min;and the changes of creatinine level pre-and post-operatively were (-5.3±3.2) μmol/L vs (-3.4±3.1) μmol/L;all above data had no significant differences respectively (t=0.696,P=0.496;t=0.214,P=0.833;t=0.022,P=0.983;t=1.375,P=0.192). There were no complications related to pedicle screw insertion in each group.
Conclusion:The novel patient-specific drill guide template can be used to assist the insertion of pedicle screws in scoliosis cases with much higher accuracy than that of freehand method and fair safety. |
| KEY WORDS Scoliosis Surgery, computer-assisted Pedicle Screw Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张宇鹏,史亚民,王华东,侯树勋.脊柱侧凸数字导航模板的准确性与安全性的病例对照研究[J].中国骨伤,2015,28(10):945~950 |
| 英文格式: | ZHANG Yu-peng,SHI Ya-min,WANG Hua-dong,HOU Shu-xun.Case-control study on accuracy and safety of patient-specific drill-guide templates used in scoliosis cases[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(10):945~950 |
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