【摘要】 [目的]探讨术中实施三维导航在脊柱侧凸病人椎弓根螺钉置入的应用价值。[方法]38例脊柱侧凸病人行三维导航引导下椎弓根螺钉固定术,其中青少年特发性脊柱侧凸18例,老年退行性脊柱侧凸20例。手术中脊柱CT三维扫描后向导航系统输入患者信息资料,用导航棒按导航指引下在最佳位置、直径和长度立体、动态地置入椎弓根螺钉。[结果]三维导航引导下成功对38例脊柱侧凸病人共置入236枚椎弓根螺钉,复查X线片和CT,无螺钉松动和断裂,按分类法:A级227枚,B级7枚,C级2枚,D级0枚。术后侧凸平均26°(21°～118°),矫正率(61%);术后后凸平均14°(5°～29°),矫正率39%。38例平均随访18个月(12～25个月),术后无脊髓或神经根损伤。[结论]三维导航引导下的脊柱侧凸椎弓根钉置入方法精确可靠。更多还原

【Abstract】 [Objective]To discuss the application research of intraoperative three-dimensional navigation in the vertebral pedicle screws implanting of patients with scoliosis.[Method]Sixteen patients with scoliosis were treated with pedicle screw fixation under the 3D navigation,among which,18 cases with adolescent idiopathic scoliosis,20 cases with senile degenerated scoliosis.The patients′ spines reveived CT 3D scanning during the operation,and then the information and data of scanning were input into the navigation system,and the navigation stick stereoscopically and dynamically implanted pedicle screws into the best location,diameter and length under the guide of navigation system.[Result]Total 236 pieces of pedicle screws were successfully implanted into 38 patients with scoliosis under the guide of 3D navigation system,the review of X-ray and CT found no loosened screw and cracking screw,according to the classification,these screws included:227 pieces in level A,7 pieces in level B,2 piece in level C,zero in level D.The radiographs taken from standing posteroanterior position and lateral side showed that the mean Cobb angle of scoliosis was corrected from preoperative 67° to post-operative 26°(21°-118°) with a correction rate of 61%.Postoperatively the angle of kyphosis was improved from the preoperative 23° to 14°(5°-29°) with a correction rate of 39%.Thirty-eight cases were received 18 months of follow-up visits on average(12-25 months),and there was no tardive spinal cord or nerve root lesion.[Conclusion]The implanting approach of screws in vertebral pedicle with scoliosis is precise and reliable under the guide of 3D navigation.更多还原