摘要
目的 比较计算机导航引导与徒手椎弓根螺钉置钉在腰椎峡部裂手术应用中的效果.方法 回顾性分析2020年1月至2023年4月新疆军区总医院脊柱外科收治的47例L5椎体双侧峡部裂患者资料.全部为男性;年龄(24.0±4.3)岁,根据置钉方法不同分为研究组(13例,采用计算机导航置钉)和对照组(34例,采用徒手置钉).记录并比较两组患者的手术切口长度、出血量、手术置钉时间、术后住院时间、住院总费用、术后并发症发生率、椎弓根螺钉的重新置钉率、椎弓根螺钉与上终板夹角度数、双侧椎弓根螺钉夹角度数、置钉准确率;比较两组患者的术前、术后1周及末次随访时的疼痛视觉模拟评分(VAS)、腰椎功能的日本骨科协会评分(JOA)、Oswestry功能障碍指数(ODI)等.末次随访时采用改良MacNab标准评价患者对手术疗效的满意度,并评估内固定失效及峡部愈合情况.结果 两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.两组患者的手术切口长度、出血量、手术置钉时间、术后住院时间、术后并发症发生率比较差异均无统计学意义(P＞0.05);研究组患者的住院总费用显著高于对照组,螺钉重置率7.7％(2/26)显著低于对照组26.5％(18/68),椎弓根螺钉与上终板夹角度数、双侧椎弓根螺钉夹角度数均显著小于对照组,置钉准确率为92.3％(24/26)显著大于对照组70.6％(48/68),差异均有统计学意义(P＜0.05).所有患者术后均获随访,时间为7.0(5.0,14.0)个月.两组患者术后1周、末次随访时疼痛VAS、JOA评分、ODI均较术前显著改善,末次随访时较术后1周进一步改善,差异均有统计学意义(P＜0.05).根据改良MacNab标准评价满意度:研究组优10例,良2例,中1例;对照组优27例,良3例,中3例,差1例.研究组内固定失效1例,1例患者发生钛缆棘突切割,峡部骨性愈合12例;对照组内固定失效2例,2例患者发生钛缆棘突切割,峡部骨性愈合29例.结论 计算机导航引导椎弓根螺钉置钉在治疗L5椎体双侧峡部裂手术中安全可靠,与徒手置钉相比具有置钉准确性较高的优势,疗效满意.
Abstract
Objective To compare the efficacy of pedicle screw placement between computer navigation guidance and freehand assistance in the surgical treatment of isthmic spondylolysis at the lumbar vertebrae.Methods A retrospective study was conducted to analyze the 47 patients with bilateral isthmic spondylolysis at the L5 vertebra who had been treated at Department of Spinal Surgery,The General Hospital of Xinjiang Military Command from January 2020 to April 2023.All were male patients with an age of(24.0±4.3)years.They were divided into a study group(13 cases subjected to pedicle screw placement assisted by computer navigation guidance)and a control group(34 cases subjected to pedicle screw placement assisted freehandedly).The 2 groups were compared in terms of surgical incision length,intraoperative bleeding,screw placement time,postoperative hospital stay,total hospitalization cost,postoperative complications,rate of screw reposition,angle between pedicle screw and upper endplate,angle between bilateral pedicle screws,and placement accuracy;the visual analogue scale(VAS)for pain,Japanese Orthopaedic Association(JOA)score for lumbar spine function,and Oswestry disability index(ODI)were also compared between preoperation,1-week postoperation,and the last follow-up.Patient satisfaction was assessed according to the modified MacNab criteria,and internal fixation fail-ure and isthmic healing were also evaluated at the last follow-up.Results There were no statistically signifi-cant differences in the preoperative general data between the 2 groups,showing comparability(P＞0.05).The differences were not statistically significant in surgical incision length,intraoperative bleeding,screw placement time,postoperative hospital stay,or postoperative complications(P＞0.05).However,in the study group,the total hospitalization cost was significantly higher than that in the control group,the rate of screw reposi-tion[7.7％(2/26)]significantly lower than that in the study group[26.5％(18/68)],the angle between pedicle screw and upper endplate and the angle between bilateral pedicle screws were both significantly smaller than those in the control group,and the placement accuracy[92.3％(24/26)]was significantly greater than that[70.6％(48/68)]in the control group(all P＜0.05).All patients were followed up for 7.0(5.0,14.0)months.Patients in both groups showed significant improvements in VAS,JOA score,and ODI at postoperative 1 week and the last follow-up compared with the preoperative values,and the improvements at the last follow-up were significantly larger than those at postoperative 1 week(P＜0.05).According to the modified MacNab cri-teria at the last follow-up,patient satisfaction was rated as excellent in 10 cases,as good in 2 cases and as moderate in 1 case in the study group while as excellent in 27 cases,as good in 3 cases,as moderate in 3 cases and as poor in 1 case in the control group.In the study group,there were 1 case of internal fixation failure,1 case of spine cutting-out by titanium cable,and 12 cases of bony healing of the isthmus;in the control group,there were 2 cases of internal fixation failure,2 cases of spine cutting-out by titanium cable,and 29 cases of bony healing of the isthmus.Conclusions In the surgical treatment of bilateral isthmic spondylolysis at the Ls vertebra,computer navigation-guided pedicle screw placement is safe and reliable,showing an advantage of higher accura-cy over freehand placement.It deserves clinical promotion due to its satisfactory therapeutic effects.
基金项目
新疆医科大学研究生创新创业项目(XJ2023G207)
新疆维吾尔自治区自然科学基金(2023D01C93)
NETL
NSTL
万方数据