• 解放軍總醫(yī)院骨科（北京，100853）;

目的探討術(shù)中CT導(dǎo)航在脊柱側(cè)凸后路胸椎椎弓根螺釘植入術(shù)中的應(yīng)用價(jià)值。 方法回顧分析2009年10月－2011年12月行脊柱后路矯形融合術(shù)的46例胸彎脊柱側(cè)凸患者臨床資料，比較術(shù)中CT導(dǎo)航下（A組，21例）和傳統(tǒng)C臂X線機(jī)下徒手（B組，25例）植入胸椎椎弓根螺釘?shù)臏?zhǔn)確性和安全性。兩組患者性別、年齡、脊柱側(cè)凸類型、累及節(jié)段、主胸彎Cobb角等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。 A、B組各植入胸椎椎弓根螺釘273枚及308枚。采用Modi等方法，通過(guò)術(shù)中CT掃描對(duì)椎弓根螺釘位置分級(jí)，計(jì)算兩組在上胸椎（T1～4）、中胸椎（T5～8）、下胸椎（T9～12）和整個(gè)胸椎（T1～12）的準(zhǔn)確植釘率、安全植釘率和潛在危險(xiǎn)植釘率。結(jié)果 A組整個(gè)胸椎的準(zhǔn)確植釘率（93.4%）、安全植釘率（98.9%）均顯著高于B組（83.8%、92.5%），潛在危險(xiǎn)植釘率（1.1%）顯著低于B組（7.5%），比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。兩組上、中、下胸椎的準(zhǔn)確植釘率、安全植釘率和潛在危險(xiǎn)植釘率比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。根據(jù)CT評(píng)估結(jié)果將潛在危險(xiǎn)植釘重新植釘或去除。術(shù)后3 d根據(jù)神經(jīng)系統(tǒng)體檢評(píng)定兩組均無(wú)神經(jīng)功能缺失發(fā)生。結(jié)論 與傳統(tǒng)C臂X線機(jī)下徒手植釘技術(shù)相比，術(shù)中CT導(dǎo)航可提高胸椎椎弓根螺釘植入的準(zhǔn)確性和安全性，可在術(shù)中發(fā)現(xiàn)危險(xiǎn)螺釘并及時(shí)去除或修正，保障手術(shù)安全。

引用本文： 施新革,張永剛,張雪松,崔庚,毛克亞,王征,董天祥,王巖. 術(shù)中CT導(dǎo)航在脊柱側(cè)凸后路胸椎椎弓根螺釘植入術(shù)中的應(yīng)用. 中國(guó)修復(fù)重建外科雜志, 2012, 26(12): 1415-1419. doi: 復(fù)制

1. 15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
2. 18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
3. 24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
4.
5.
6. Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
7. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
8. Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
9. Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
10. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
11. Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
12. Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
13. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
14. Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
15. Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
16. Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
17. Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
18. Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
19. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
20. Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
21. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
22. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
23. Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
24. Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
25. Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
26. Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.
  1. 1. 15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
  2. 2. 18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
  3. 3. 24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
  4. 4.
  5. 5.
  6. 6. Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
  7. 7. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
  8. 8. Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
  9. 9. Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
  10. 10. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
  11. 11. Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
  12. 12. Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
  13. 13. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
  14. 14. Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
  15. 15. Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
  16. 16. Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
  17. 17. Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
  18. 18. Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
  19. 19. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
  20. 20. Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
  21. 21. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
  22. 22. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
  23. 23. Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
  24. 24. Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
  25. 25. Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
  26. 26. Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.