Ma Angran,Wen Wangqiang,Li Guojun,et al.Navigation-guided transverse process trajectory technique for pedicle screw placing at apical vertebral region in adolescent idiopathic scoliosis[J].Journal of Clinical Pediatric Surgery,2025,(02):143-151.[doi:10.3760/cma.j.cn101785-202408041-008]
导航引导下横突轨迹技术在青少年特发性脊柱侧凸顶椎区置钉中的应用
- Title:
- Navigation-guided transverse process trajectory technique for pedicle screw placing at apical vertebral region in adolescent idiopathic scoliosis
- Keywords:
- Adolescent Idiopathic Scoliosis; Orthopedic Procedures; Intraoperative Navigation Technology; Transverse Process Trajectory Technique; Treatment Outcome; Screw Placement Accuracy; Pedicle Screw
- 摘要:
- 目的 比较在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)手术中,采用徒手技术(free hand technique,FH)结合横突轨迹技术(transverse process trajectory technique,TPT)和术中导航技术(intraoperative navigation technology,INT)结合TPT技术,在顶椎区置入椎弓根螺钉时偏出程度及方向上的差异,探讨AIS患者顶椎区椎弓根解剖形态以及TPT技术、计算机导航辅助技术在AIS手术中的应用效果,分析计算机导航辅助技术与TPT技术相结合的临床应用价值。方法 回顾性分析2021年8月至2023年12月于海南医科大学第一附属医院接受后路脊柱侧凸矫形内固定手术的33例AIS患儿临床资料,其中采用FH结合TPT技术16例,为FH组;采用INT结合TPT技术17例,为INT组。收集两组患儿性别、年龄、Risser征等基本资料及影像学检查数据,利用手术后CT扫描及三维重建技术,记录椎弓根螺钉穿透骨皮质的具体位置,并精确测量穿透部分的长度。结果 两组患儿性别、年龄、Risser征等比较,差异均无统计学意义(P＞0.05)。INT组的主弯矫形率为(88.82±1.97)%,优于FH组的(85.36±3.16)%;顶椎区置钉时间为(2.65±1.28) min,较FH组的(4.24±2.10) min缩短;以上差异均具有统计学意义(P<0.05)。FH组顶椎区共置入椎弓根螺钉113枚,INT组156枚;FH组可接受椎弓根螺钉数为90枚(占总数的79.7%),少于INT组的139枚(占总数的89.1%)。两组0级钉比较,差异有统计学意义(P<0.05),主要在凸侧;1级钉凹、凸侧差异均有统计学意义(P<0.05);2级钉差异无统计学意义(P＞0.05);3级钉仅在两组凹侧差异有统计学意义(P<0.05)。在INT组中,穿透椎弓根内、外侧皮质的数量占该组置钉总数的8.3%和7.05%,低于FH组的19.5%和21.2%,差异具有统计学意义(P<0.05)。两组均无一例出现严重并发症。结论 与FH结合TPT技术相比,INT结合TPT技术能够实时监测和有效提升整体椎弓根螺钉置入的精确度,降低椎弓根内、外侧骨皮质穿透发生率,是一种提高AIS矫形内固定手术精确性的可靠方法。
- Abstract:
- Objective To compare the deviation degree and direction of pedicle screw placement in apex region during corrective surgery for adolescent idiopathic scoliosis (AIS) using free hand (FH) plus transverse process trajectory (TPT) versus intraoperative navigation technology (INT) plus TPT.Additionally,the study explored anatomical morphology of pedicles in apex region of AIS children,application of TPT,clinical application value of computer-assisted navigation technology and combination of intraoperative navigation with TPT in selecting screw insertion points,as well as clinical application value of INT technology during AIS surgery. Methods A retrospective analysis was conducted for 33 AIS children undergoing posterior spinal deformity correction plus internal fixation from 2021 to 2023.Sixteen children undergoing operations with free hand (FH) plus transverse process trajectory (TPT) were selected as FH group.And another 17 children undergoing operations with intraoperative navigation technology (INT) plus TPT were designated as INT group.Basic profiles and radiographic findings of both groups were collected.The positions of pedicle screw penetration through cortical bone were documented with postoperative computed tomography (CT) and three-dimensional reconstruction techniques.And the distances of penetration were measured. Results In terms of gender,age and Risser sign,no statistically significant inter-group differences existed.However,in terms of treatment outcomes,main curve correction rate was (88.82±1.97)% in INT group.It was superior to (85.36±3.16)% in FH group and this difference was statistically significant (P<0.05).Average time for pedicle screw placement in apex vertebral region was (2.65±1.28) min in INT group and it was shorter than (4.24±2.10) min in FH group.And the difference was also statistically significant (P<0.05).A total of 113 pedicle screws were placed in apex vertebral region in FH group while 156 screws in INT group.FH group had an acceptable number of pedicle screws at 90,accounting for 79.7% of total.It was less than 139 screws in INT group,accounting for 89.1% of total.Statistically significant inter-group difference existed in the number of grade 0 screws at mostly convex side.Inter-group differences existed in grade 1 screws at both concave and convex sides (P<0.05).No statistically significant difference existed in grade 2 screws and statistically significant inter-group differences in grade 3 screws only at concave side (P<0.05).INT group had lower rates of penetration through medial and lateral walls of pedicle than FH group.In INT group,the number of screws penetrating medial and lateral cortices accounted for 8.3% and 7.05% of total screws in INT group.It was lower than 19.5% and 21.2% in FH group.Statistically significant inter-group difference existed (P<0.05).No serious complications occurred in neither groups. Conclusions As compared with FH plus TPT,INT plus TPT enables real-time monitoring,effectively enhances the accuracy of overall pedicle screw placement and lowers the rate of penetration through medial and lateral cortices of pedicle.It proves to be a reliable method of improving the precision of AIS during corrective internal fixation.
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备注/Memo
收稿日期:2024-8-26。
基金项目:国家自然科学基金(82160435,81902270)
通讯作者:陈焕雄,Email:chenhuanxiong86@163.com