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
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 failure and isthmic healing were also evaluated at the last follow-up.Results There were no statistically significant 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 reposition[7.7%(2/26)]significantly lower than that in the study group[26.5%(18/68)],the angle between pedicle screw and upper endplate
作者
李璐遥
黄晓夏
马锐
刘涛
李强
安伟
阿不都艾孜孜·麦麦提
滕勇
Li Luyao;Huang Xiaoxia;Ma Rui;Liu Tao;Li Qiang;An Wei;Abuduaizizi Maimaiti;Teng Yong(College of Postgraduate Medicine,Xinjiang Medical University,Urumqi 830000,China;Department of Spinal Surgery,The General Hospital of Xinjiang Military Command,Urumqi 830000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2024年第1期35-42,共8页
Chinese Journal of Orthopaedic Trauma
基金
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)。
关键词
外科手术
计算机辅助
内固定器
腰椎
峡部裂
Surgery,computer-assisted
Internal fixators
Lumbar vertebrae
Spondylolysis
