■前瞻性实验研究。
■在模拟实验室中比较O-Arm获得的X线照相和计算机断层扫描(CT)评估胸椎椎弓根螺钉放置与开放椎板切除术的准确性。
■提高胸椎后路器械手术安全性和手术效率对于降低并发症发生率和可能的相关风险至关重要。在手术过程中和术后立即验证椎弓根螺钉位置的最常见方法是获取术中透视图和脊柱平片,分别。实验室模拟手术是评估这些检查准确性的有价值的工具。
■20个从T3到T7的脊柱侧凸模拟模型由5个脊柱研究员(总共200个椎弓根螺钉)进行了测量,然后是在O-Arm的帮助下获得的X线照相和CT图像,由三名独立的评估者进行评估。受过研究训练的脊柱神经外科医生在仪器水平上进行了椎板切除术,并评估了椎弓根完整性(金标准)。
■椎板切除术后,在轴向直视图中发现了48个裂口。其中,18项违规行为被归类为不可接受。关于矢状直视,观察到四次违规,其中三个被列为不可接受。总的来说,O型臂射线照相和CT评估均具有明显较高的负预测值,但在识别不可接受的破坏方面具有较低的正预测值,尤其是在矢状面.所有三位考官错过违规的频率都很高,特别是在矢状面。
■使用O形臂获取的X线照相或CT图像对椎弓根螺钉的术后评估可能对破裂的存在诊断不足。在我们的研究中,矢状破裂比轴向破裂更难以诊断。虽然大多数违规行为没有临床影响,本研究提示这种术后影像学评估方式可能不准确.
■4.
UNASSIGNED: Prospective experimental study.
UNASSIGNED: To compare the accuracy of O-Arm-acquired radiographic and computed tomography (CT) evaluation of thoracic pedicle screw placement with open laminectomy in a simulation laboratory.
UNASSIGNED: Improving surgical safety and procedural efficiency during thoracic posterior spine instrumentation is essential for decreasing complication rates and possible related risks. The most common way of verifying the position of pedicle screws during the surgical procedure and immediately postoperatively is to acquire intraoperative fluoroscopic images and plain radiographs of the spine, respectively. Laboratory simulated surgery is a valuable tool to evaluate the accuracy of those exams.
UNASSIGNED: Twenty simulation models of scoliosis from T3 to T7 were instrumented by five spine fellows (total of 200 pedicle screws), followed by radiographic and CT images acquired with the assistance of the O-Arm which were evaluated by three independent raters. A fellowship-trained spine neurosurgeon performed laminectomies on the instrumented levels and assessed pedicle integrity (gold standard).
UNASSIGNED: Forty-eight breaches were identified in the axial direct view after laminectomy. Of those, eighteen breaches were classified as unacceptable. Regarding the sagittal direct view, four breaches were observed, three of which were classified as unacceptable. Overall, both O-arm radiographic and CT evaluations had a significantly high negative predicted value but a low positive predicted value to identify unacceptable breaches, especially in the sagittal plane. The frequency of missed breaches by all three examiners was high, particularly in the sagittal plane.
UNASSIGNED: Postoperative evaluation of pedicle screws using O-arm-acquired radiographic or CT images may underdiagnose the presence of breaches. In our study, sagittal breaches were more difficult to diagnose than axial breaches. Although most breaches do not have clinical repercussions, this study suggests that this modality of postoperative radiographic assessment may be inaccurate.
UNASSIGNED: 4.