摘要
目的:分析混合现实(mixed reality,MR)辅助椎弓根钉棒内固定系统(pedicle screw-rod system,PSRS)治疗退变性腰椎滑脱(degenerative lumbar spondylolithesis,DLS)的临床疗效。方法:选取采用PSRS手术治疗19例DLS患者,其中MR-PSRS(干预组)手术10例,常规C-PSRS(对照组)手术9例。术前进行数字化三维重建和椎弓根螺钉CAD设计,术中利用混合现实图像进行手术,并与术后测量值对比。结果:MRPSRS手术前通过CAD设计模拟测量的椎弓根螺钉直径、长度、CA、PSEA、支撑棒长度的设计值与实际手术使用值无统计学差异;术后X线显示,MR-PSRS手术的CA、PSEA偏移值均<2°,明显优于C-PSRS手术。MRPSRS的手术时间、术中出血量、术后引流量、透视次数、平均住院时间均优于C-PSRS组,差异有统计学意义;MR-PSRS术后1 d、7 d的日本骨科协会评估治疗分数(Japanese orthopaedic association scores,JOA)临床评分,术后7 d、14 d的Oswetry功能障碍指数(Oswetry disability index,ODI)功能评分均优于C-PSRS手术,差异有统计学意义,术后1 d的ODI,1月、3月的JOA、ODI和1 d、7 d、14 d、1月、3月VAS评分差异无统计学意义。结论:MR-PSRS技术能够在术前通过CAD设计,获得精确的手术计划,并获得良好的手术精度;其手术精准度、手术后早期恢复均优于C-PSRS技术。
Objective:To analyze the clinical efficacy of the pedicle screw-rod system(PSRS)assisted by mixed reality(MR)in the treatment of degenerative lumbar spondylolithesis(DLS).Methods:19 DLS patients treated by PSRS surgery were selected,including 10 cases of MR-PSRS(intervention group)surgery and 9 cases of conventional PSRS(control group)surgery.Before the surgery,the digital 3 D reconstruction and the CAD design of the pedicle screw were completed.During the surgery,the MR images were used to perform the surgery and compared with the postoperative measured values.Results:The diameter,length,CA,PSEA and the length of the supporting rod of the pedicle screw were simulated and measured by CAD design before the MR-PSRS surgery.Their design values and the actual values used in the surgery were not significantly different.The postoperative X-ray showed that the deviations of CA and PSEA in the MR-PSRS surgery were both less than 2°,which were significantly superior to those in the C-PSRS surgery.The surgery time,intraoperative blood loss,postoperative drainage volume,number of X-ray examinations and average hospital stay of the MR-PSRS group were superior to those of the C-PSRS group.The differences were statistically significant.The clinical score of JOA 1 d and 7 d after the MR-PSRS surgery and the functional score of ODI 7 d and 14 d after the surgery were superior to those of the C-PSRS surgery.The differences were statistically significant.There was no statistically significant difference in ODI 1 d after the surgery,JOA and ODI 1 month and 3 months after the surgery,and VAS scores 1 d,7 d,14 d,1 month and 3 months after the surgery.Conclusion:With the MR-PSRS technique,we can make the accurate surgical plan and have a high surgical precision by CAD design before the surgery.The surgical accuracy and early recovery after the surgery were superior to those of the conventional PSRS technique.
出处
《中国数字医学》
2021年第6期71-76,共6页
China Digital Medicine
基金
江苏省研究生科研创新计划(编号:KYCX20_1432)
江苏省研究生实践创新计划(编号:SJCX19_0329)
南京市医学科技发展资金资助项目(编号:ZKX18029)
