【摘要】 目的探讨计算机CT三维导航系统辅助下进行颈椎椎弓根螺钉内固定的可行性和置钉精确性。方法总结CT三维导航系统辅助下置入的159枚颈椎(C2-7)椎弓根螺钉,术后进行经椎弓根螺钉水平的CT平扫,观察椎弓根螺钉置入的精确性。同时总结X线透视引导下145枚颈椎椎弓根螺钉的置钉准确性,并与CT三维导航引导组进行对比分析。并对其中20例患者进行术中导航操作时间和精确性的监测。结果CT三维导航系统引导组螺钉置入满意率为97.5%,X线透视引导组螺钉置入满意率为91.7%,两组满意率差异有显著性意义(P<0.05)。导航组位置不满意的4枚螺钉均发生于早期病例,导航系统使用熟练后未再出现置钉不满意病例。两组病例均未出现明显的神经、血管损伤并发症。术中工具注册和参考点照合时间平均3.5min(2～8min),位置误差率平均0.31mm(0.12～0.56mm,导航仪自动计算)。每枚椎弓根螺钉定位针置入所需时间平均2min(1～3.5min)。术中只需进行2次C型臂X线机透视印证螺钉定位针和螺钉置入的准确性。结论采用CT三维导航系统辅助进行颈椎椎弓根螺钉内固定是可行的,与X线透视引导相比,能显著提高椎弓根螺钉置入的精确性、安全性。更多还原

【Abstract】 Objective To evaluate the feasibility and accuracy of cervical pedicle screw fixation when assisted by CT-based navigation system. Methods 159 pedicle screws inserted by CT-based navigation system and 145 cervical (C2-C7) pedicle screws inserted by X-ray fluoroscopy were observed by postoperative CT scan. The accuracy of both series was compared. The process of navigation was investigated. The process of navigation was investigated in 20 patients. Results Of the 159 screws inserted by CT-based navigation system, 155 were accurate (97.5%); misplacement of the 4 screws occurred because of unskillful application of the navigation system. Of the 145 screws inserted by X-ray fluoroscopy, 133 were accurate (91.7%). The difference was statistically significant( P< 0.05). The mean time for registration and matching was 3.5 minutes. The mean time for screw-marker insertion was 2 minutes. Conclusion CT-based navigation system can increase accuracy of cervical pedicle screw fixation obviously.更多还原