背景：脊柱后路椎弓根螺钉置入内固定是治疗脊柱各种病变及稳定脊柱的重要手段，计算机导航技术可以完整、直观、真实地再现各种组织形态及其相对位置，使术者实时获得三维图像信息，最大限度地避开手术危险区，直接引导内固定螺钉准确置入椎体。目的：评估计算机导航技术辅助脊柱后路椎弓根螺钉置入的准确性及安全性。方法：选择2008年7月至2014年1月在广西医科大学第一附属医院治疗的307例脊柱病变患者在计算机导航辅助下行脊柱后路椎弓根钉置入及椎板切除减压。术中行C臂透视检查螺钉位置的精确性，记录每枚螺钉的平均置钉时间、射线暴露时间，术后3 d复查X射线和置钉节段的三维CT，根据Andrew椎弓根螺钉CT位置分级标准对置钉位置进行评估。结果与结论：共置入螺钉1820枚，1778枚为Ⅰ级螺钉(准确率97.69%)。其中颈椎置入螺钉92枚，Ⅰ级螺钉90枚(准确率97.82%)，胸椎置入螺钉502枚，Ⅰ级螺钉492枚，准确率98%，腰椎置入螺钉1226枚,Ⅰ级螺钉1196，准确率97.2%。每枚螺钉的平均置钉时间(7.0±1.5) min。215例获随访，随访时间(12±6)个月，无内固定物移位、断裂等并发症以及神经血管损伤发生。提示计算机导航技术辅助脊柱椎弓根钉置入，能立体、多视角实时显示骨性解剖结构，保证了脊柱椎弓根钉置入的准确性及安全性，明显减少放射线的暴露强度。%BACKGROUND:Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body. OBJECTIVE:To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.METHODS:307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical University from July 2008 to January 2014, were enrol ed in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which al owed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely. RESULTS AND CONCLUSION:Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69%). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were fol owed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.
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