目的:导航模板的不完美配合会导致手术时间延长和失血量增加。这些问题在以往的研究中没有得到有效解决。本研究探讨了新型5点定位点接触椎弓根导航模板在脊柱侧凸复杂椎弓根情况下的功效。
方法:本研究采用回顾性对照设计。2019年11月至2023年11月,选取28例脊柱侧凸合并复杂椎弓根患者,行脊柱侧凸矫正术。术中使用5点定位点接触椎弓根导航模板来指导椎弓根螺钉的放置。以56例历史病例作为对照组。分析包括螺钉放置时间,螺钉放置出血量,透视频率,手动重新定位频率,螺钉放置精度和等级,螺钉放置并发症,和主曲线修正率。使用独立样本t检验比较连续变量。分类数据分析采用卡方检验。
结果:所有28例患者均成功接受了手术,共放置268颗椎弓根螺钉。手术时间为220至410分钟,平均(283.16±51.26)min。术中失血630~1900mL,平均(902.17±361.25)mL。椎弓根螺钉放置时间为60~130min,平均(85.24±24.65)min。椎弓根螺钉置入出血量40~180mL,平均(76.47±42.65)mL。透视次数3-7次,平均(4.31±1.14)次。手动重定位频率范围为0到2倍,平均(0.46±0.58)次。椎弓根螺钉放置等级:I级:237个螺钉;II级:25个螺钉;III级:6个螺钉;IV级:0个螺钉。无螺钉相关并发症。矫正率从46%到68%不等,平均(55.83±9.22)%。与经验丰富的螺丝组相比,螺钉放置时间的差异,螺钉放置出血量,荧光检查程序,和手动重定向有统计学意义(p<0.05)。
结论:5点定位点接触椎弓根导航模板具有爪状结构,可牢固地适应各种变形的椎骨小关节,避免漂移现象和确保准确的螺钉放置。其与脊柱椎板的尖锐接触结构避免了后部结构的广泛和完全脱离,减少失血,手术时间,和创伤。预先设计的椎弓根螺钉进入点和方向减少了透视频率和手术时间。
OBJECTIVE: Imperfect fitting of the navigation template leads to prolonged surgery time and increased blood loss. These problems have not been effectively addressed in previous research. This study explores the efficacy of a novel 5-point positioning point-contact pedicle navigation template in complex pedicle situations in scoliosis.
METHODS: This study employed a retrospective controlled design. From November 2019 to November 2023, 28 patients with scoliosis and complex pedicle were selected and underwent scoliosis correction surgery. A 5-point positioning point-contact pedicle navigation template was used intraoperatively to guide pedicle screw placement. Matched with 56 historical cases as a control group. The analysis included screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual repositioning frequency, screw placement accuracy and grade, screw placement complications, and main curve correction rate. Continuous variables were compared using the independent samples t-test. Categorical data were analyzed with the chi-square test.
RESULTS: All 28 patients successfully underwent surgery, with a total of 268 pedicle screws placed. The surgery duration ranged from 220 to 410 min, with an average of (283.16 ± 51.26) min. Intraoperative blood loss ranged from 630 to 1900 mL, with an average of (902.17 ± 361.25) mL. Pedicle screw placement time ranged from 60 to 130 min, with an average of (85.24 ± 24.65) min. Pedicle screw placement bleeding volume ranged from 40 to 180 mL, with an average of (76.47 ± 42.65) mL. Fluoroscopy frequency ranged from 3 to 7 times, with an average of (4.31 ± 1.14) times. Manual repositioning frequency ranged from 0 to 2 times, with an average of (0.46 ± 0.58) times. Pedicle screw placement grades: Grade I: 237 screws; Grade II: 25 screws; Grade III: 6 screws; Grade IV: 0 screws. There were no screw-related complications. The correction rate ranged from 46% to 68%, with an average of (55.83 ± 9.22)%. Compared to the experienced screw group, the differences in screw placement time, screw placement bleeding volume, fluoroscopy procedures, and manual redirections were statistically significant (p < 0.05).
CONCLUSIONS: The 5-point positioning point-contact pedicle navigation template features a claw-like structure that securely adapts to various deformed vertebral facet joints, avoiding drift phenomena and ensuring accurate screw placement. Its pointed contact structure with the lamina of the spine avoids extensive and complete detachment of posterior structures, reducing blood loss, surgery time, and trauma. Predesigned pedicle screw entry points and directions reduce fluoroscopy frequency and surgery time.