临床小儿外科杂志2025，Vol.24Issue(2)：143-151,9.DOI:10.3760/cma.j.cn101785-202408041-008
导航引导下横突轨迹技术在青少年特发性脊柱侧凸顶椎区置钉中的应用
Navigation-guided transverse process trajectory technique for pedicle screw placing at apical vertebral region in adolescent idiopathic scoliosis
摘要
Abstract
Objective To compare the deviation degree and direction of pedicle screw placement in apex region during corrective surgery for adolescent idiopathic scoliosis(AIS)using free hand(FH)plus transverse process trajectory(TPT)versus intraoperative navigation technology(INT)plus TPT.Additionally,the study explored anatomical morphology of pedicles in apex region of AIS children,application of TPT,clinical applica-tion value of computer-assisted navigation technology and combination of intraoperative navigation with TPT in selecting screw insertion points,as well as clinical application value of INT technology during AIS surgery.Methods A retrospective analysis was conducted for 33 AIS children undergoing posterior spinal deformity cor-rection plus internal fixation from 2021 to 2023.Sixteen children undergoing operations with free hand(FH)plus transverse process trajectory(TPT)were selected as FH group.And another 17 children undergoing opera-tions with intraoperative navigation technology(INT)plus TPT were designated as INT group.Basic profiles and radiographic findings of both groups were collected.The positions of pedicle screw penetration through corti-cal bone were documented with postoperative computed tomography(CT)and three-dimensional reconstruction techniques.And the distances of penetration were measured.Results In terms of gender,age and Risser sign,no statistically significant inter-group differences existed.However,in terms of treatment outcomes,main curve correction rate was(88.82±1.97)％in INT group.It was superior to(85.36±3.16)％in FH group and this difference was statistically significant(P＜0.05).Average time for pedicle screw placement in apex vertebral re-gion was(2.65±1.28)min in INT group and it was shorter than(4.24±2.10)min in FH group.And the difference was also statistically significant(P＜0.05).A total of 113 pedicle screws were placed in apex vertebral region in FH group while 156 screws in INT group.FH group had an acceptable number of pedicle screws at 90,accounting for 79.7％of total.It was less than 139 screws in INT group,accounting for 89.1％of total.Statisti-cally significant inter-group difference existed in the number of grade 0 screws at mostly convex side.Inter-group differences existed in grade 1 screws at both concave and convex sides(P＜0.05).No statistically significant difference existed in grade 2 screws and statistically significant inter-group differences in grade 3 screws only at concave side(P＜0.05).INT group had lower rates of penetration through medial and lateral walls of pedicle than FH group.In INT group,the number of screws penetrating medial and lateral cortices accounted for 8.3％and 7.05％of total screws in INT group.It was lower than 19.5％and 21.2％in FH group.Statistically signifi-cant inter-group difference existed(P＜0.05).No serious complications occurred in neither groups.Conclu-sions As compared with FH plus TPT,INT plus TPT enables real-time monitoring,effectively enhances the ac-curacy of overall pedicle screw placement and lowers the rate of penetration through medial and lateral cortices of pedicle.It proves to be a reliable method of improving the precision of AIS during corrective internal fixation.关键词
青少年特发性脊柱侧凸/矫形外科手术/术中导航技术/横突轨迹技术/治疗结果/置钉精确性/椎弓根螺钉Key words
Adolescent Idiopathic Scoliosis/Orthopedic Procedures/Intraoperative Navigation Technol-ogy/Transverse Process Trajectory Technique/Treatment Outcome/Screw Placement Accuracy/Pedicle Screw引用本文复制引用
马昂然,陈焕雄,文王强,李国军,何贤波,汤三泉,王文博,林有才,林素羽,潘松利..导航引导下横突轨迹技术在青少年特发性脊柱侧凸顶椎区置钉中的应用[J].临床小儿外科杂志,2025,24(2):143-151,9.基金项目
国家自然科学基金(82160435,81902270) National Natural Science Foundation of China(82160435 & 81902270) （82160435,81902270）
