| 李坤,陈志龙,余国庆,等.3D导航引导与徒手椎板关节突螺钉置钉在单节段腰椎融合手术中的应用比较.骨科,2021,12(6): 493-498. |
| 3D导航引导与徒手椎板关节突螺钉置钉在单节段腰椎融合手术中的应用比较 |
| Comparative Study of 3D Navigation Guidance vs. Free Hand Lamina Articular Screw Placement in Single Level Lumbar Fusion |
| 投稿时间：2021-04-09 |
| DOI：10.3969/j.issn.1674-8573.2021.06.002 |
| 中文关键词: 脊柱融合术 腰椎 外科手术，计算机辅助 对比研究 |
| 英文关键词: Spinal fusion Lumbar vertebrae Surgery, computer-assisted Comparative study |
| 基金项目:湖北省卫生健康委员会科研项目（WJ2021F078） |
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| 中文摘要: |
| 目的 比较3D导航引导与徒手椎板关节突螺钉置钉在单节段腰椎融合手术中的疗效。方法 纳入2020年1月至10月我院骨科收治的拟行单节段腰椎融合手术的病人30例，按参与研究的奇偶顺序分为两组，3D导航组15例，行3D导航引导下椎板关节突螺钉置钉，徒手置钉组15例，行徒手椎板关节突螺钉置钉。统计两组病人的术中透视次数、操作时间、术中失血量及24 h引流量，拔除引流管后统计并对比两组的置钉准确性，分别于术后第1、3、7天测量两组的红细胞沉降率（ESR）及C反应蛋白（CRP）水平，同时对比两组的日本矫形外科协会（JOA）评分改善情况及椎间融合情况。结果 两组病人均顺利完成手术，未予以输血。3D导航组的术中透视次数、手术时间、术中失血量及引流量分别为（2.43±0.25）次、（110.86±10.75） min、（150.45±23.46） mL、（83.87±10.63） mL，徒手置钉组分别为（6.52±1.21）次、（152.37±13.45） min、（213.68±34.68） mL、（156.84±15.67） mL，3D导航组各项手术指标均优于徒手置钉组（P＜0.05）；3D导航组的置钉准确性显著优于徒手置钉组（100% vs. 73.33%，P＜0.05）；术后第1、3、7天时，3D导航组的ESR、CRP均较徒手置钉组显著降低（P＜0.05）；末次随访时，3D导航组的JOA改善率为75.00%，稍高于徒手置钉组的72.41%，但两组对比，差异无统计学意义（P＞0.05）。随访期间，两组均达到良好椎间融合，无椎间融合期移位、螺钉断裂、松动或移位等情况出现。结论 3D导航引导与徒手椎板关节突螺钉置钉均可有效改善单节段腰椎融合手术病人的JOA评分，但与徒手置钉相比，3D导航引导下椎板关节突螺钉置钉可改善病人手术指标，提升置钉准确性，降低术后ESR和CRP，可作为腰椎椎板关节突螺钉置钉的优先选择方案。 |
| 英文摘要: |
| Objective To compare the effect of laminar process screw placement under the guidance of 3D navigation and free-hand laminar process screw placement. Methods From January to October 2020, 30 patients with single segment lumbar fusion were treated in Department of Orthopedics of our hospital. They were divided into two groups according to the parity order of the participants in the study. A total of 15 patients in the 3D navigation group received the placement of the lamina articular screw under the guidance of 3D navigation, and 15 patients in the free-hand group received the placement of the lamina articular screw by hand. The intraoperative fluoroscopy times, operation time, intraoperative blood loss, drainage volume and the accuracy of nail placement were recorded. The rythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured at 1, 3, and 7 days after surgery. At the same time, the improvement of the Japanese Orthopaedic Association (JOA) score was compared between the two groups. Results The operations of the two groups were successfully completed without blood transfusion and complications. The intraoperative fluoroscopy times, operation time, intraoperative blood loss and drainage volume in the 3D navigation group were 2.43±0.25, (110.86±10.75) min, (150.45±23.46) mL, (83.87±10.63) mL, and those in the free-hand nail group were 6.52±1.21, (152.37±13.45) min, (213.68±34.68) mL, (156.84±15.67) mL, respectively. All surgical indexes in 3D navigation group were better than those in free-hand nail group (P＜0.05). In the 3D navigation group, the screw position was better than the free-hand nailing group (P＜0.05). In the 3D navigation group, the ESR and CRP levels at 1, 3, and 7 days postoperatively were lower than the free-hand nail group (P＜0.05). In the 3D navigation group, the JOA improvement rate at the last follow-up was 75.00%, which was slightly higher than 72.41% in the free-hand nail group (P＞0.05). During the follow-up period, there was no dislocation during the intervertebral fusion, and no screw breakage, loosening or dislocation occurred in the two groups. Conclusion The 3D navigation-guided laminar process screw placement and freehand laminar process screw placement can effectively improve the JOA score of patients with single-segment lumbar fusion surgery, but the 3D navigation-guided lamina articular process screw placement can improve the patient's surgical indicators, increase the accuracy of the placement, and reduce the degree of postoperative ESR and CRP more significantly than the freehand laminar process screw placement. The 3D navigation-guided lamina articular process screw placement can be used as the first choice for lumbar facet screw placement. |
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