Comparison of ultrasound volume navigation and O-arm navigation in percutaneous pedicle screw fixa-tion for thoracolumbar vertebral fractures
赵刚 1林旭鑫 1沈素红 2常青 1尚利杰 1付卓 2付晓燕 1付豪 1王怡帆 1周鹭凡1
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作者信息
1. 河南省洛阳正骨医院(河南省骨科医院)脊柱微创一科,洛阳 471000
2. 河南省洛阳正骨医院(河南省骨科医院)功能检查科,洛阳 471000
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摘要
目的 比较超声容积导航(UVN)与O型臂导航引导经皮椎弓根螺钉内固定治疗胸腰椎骨折的效果.方法 回顾性分析2022年1月至2023年6月期间河南省洛阳正骨医院脊柱微创一科采用经皮椎弓根螺钉内固定治疗的29例胸腰椎骨折患者资料.根据导航方法不同分为两组:UVN组17例,男14例,女3例;年龄50.0(44.0,53.5)岁;在UVN引导下置入椎弓根螺钉;O型臂组12例,男10例,女2例;年龄(40.6±11.1)岁;在O型臂导航引导下置入椎弓根螺钉.比较两组患者的每枚螺钉置入时间、术中总辐射剂量、每枚螺钉辐射剂量、置钉准确率、关节突关节侵犯率及术后1、3、6个月腰部疼痛视觉模拟评分(VAS)等.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.UVN组与O型臂组患者的每枚螺钉置入时间[(13.2±1.3)、(14.1±1.3)min]比较差异无统计学意义(P＞0.05).UVN组患者的术中总辐射剂量和每枚螺钉辐射剂量[(1.80±0.54)、(0.41±0.10)mSv]显著低于 O 型臂组患者[(3.52±0.33)、(0.85±0.11)mSv],差异均有统计学意义(P＜0.05).UVN组患者的置钉准确率[94.7％(71/75)]、关节突关节侵犯率[17.6％(3/17)]与O型臂组患者[92.2％(47/51)、8.3％(1/12)])比较差异均无统计学意义(P＞0.05).术后1个月,UVN组患者的疼痛VAS评分[4.0(3.5,5.0)分]显著低于O型臂组患者[5.0(5.0,6.0)分],差异有统计学意义(P＜0.05);而两组患者术后3、6个月的疼痛VAS评分比较差异均无统计学意义(P＞0.05).结论 在经皮椎弓根螺钉内固定治疗胸腰椎骨折中,UVN引导下置钉具有与O型臂导航引导下置钉一致的省时性、直观性、精确性,且在辐射规避和疼痛缓解方面优于O型臂导航引导下置钉.
Abstract
Objective To compare the efficacy of ultrasound volume navigation(UVN)and that of O-arm navigation in the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation.Methods A retrospective study was conducted to analyze the clinical data of 29 patients with thoracolumbar vertebral fracture who had been treated with percutaneous pedicle screw fixation at Department Ⅰof Minimally Invasive Spinal Surgery,Luoyang Orthopedic Hospital from January 2022 to June 2023.The pa-tients were assigned into 2 groups according to different navigation methods.In group UVN of 17 cases,there were 14 males and 3 females with a mean age of 50.0(44.0,53.5)years,and the pedicle screw fixation was guided by UVN;in group O-arm of 12 cases,there were 10 males and 2 females with an age of(40.6±11.1)years,and the pedicle screw fixation was guided by O-arm navigation.The 2 groups were compared in terms of insertion time per screw,total dose of intraoperative radiation,radiation dose per screw,accuracy of screw placement,rate of facet joint violation,and visual analogue scale(VAS)pain scores for lumbar pain at postop-erative 1,3,and 6 months.Results There were no statistically significant differences in the preoperative general data between the 2 groups,indicating comparability(P＞0.05).There was no statistically significant difference in the insertion time per screw between group UVN and group O-arm[(13.2±1.3)min versus(14.1±1.3)min](P＞0.05).The total dose of intraoperative radiation and radiation dose per screw in group UVN[(1.80±0.54)mSv and(0.41±0.10)mSv]were significantly lower than those in group O-arm[(3.52±0.33)mSv and(0.85±0.11)mSv](P＜0.05).The accuracy of screw placement and rate of facet joint violation in group UVN[94.7％(71/75)and 17.6％(3/17)]were not significantly different from those in group O-arm[92.2％(47/51)and 8.3％(1/12)]](P＞0.05).The VAS score at postoperative 1 month in group UVN[4.0(3.5,5.0)points]was significantly lower than that in group O-arm[5.0(5.0,6.0)points](P＜0.05).There were no statistically significant differences between the 2 groups in the VAS pain scores at postoperative 3 and 6 months(P＞0.05).Conclusions In the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation,screw placement guided by UVN is as time-saving,intuitive,and accurate as that guided by O-arm navigation.However,UVN is better than O-arm navigation in radiation avoidance and pain relief.
维普
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