Application of pedical screw visualization technique in screw placement of lumbar vertebrae fracture

doi:10.3969/j.issn.2095-4344.2014.04.010

Abstract

Abstract:

BACKGROUND: Three-dimensional visualization technique has been widely used in clinical treatment. Preoperative visualization technique allows safe demonstration on the complex spine fracture models, and also prepare screw placement scheme according to three-dimensional model of patients.

OBJECTIVE: To discuss the clinical result of treating short-segment lumbar vertebrae fracture with pedicle screw visualization.

METHODS: A total of 32 patients with lumbar vertebrae fracture were treated with 182 pedicle screws. Before the screw implantation, the structure of bilateral pedicle was observed using Mimics software and the implantation parameters were measured. The operation methods and related complications were told to the patients through the reconstructed three-dimensional images. The satisfaction of the patients, operation time, and the position of pedicle screws by postoperative CT scan were assessed. The percentages of anterior vertebral height and Cobb’s angle were measured before operation, 2 weeks after operation and 8 months after operation.

RESULTS AND CONCLUSION: The excellent satisfaction rate of the patients was 100%, the mean operation time was 185 minutes, and 173 pedicle screws (95.1%) were totally inserted within the pedicle. All patients were followed up for 7-22 months. The results showed that the fracture healed well. The percent of anterior vertebral height and Cobb’s angle at 2 weeks after operation were significantly decreased compared with them before operation

(P < 0.05). There were no significant difference about the percent of anterior vertebral height and Cobb’s angle between 2 weeks and 8 months follow-up (P > 0.05). Single-segment lumbar vertebrae fracture was well treated by the pedicle screw visualization technique. This method assists to make up preoperation plan, increase the rate of patients’ satisfaction, shorten operation time, and increase the accuracy of pedicle screw insertion.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar vertebra, fracture, fracture fixation, imaging, three-dimensional, follow-up

CLC Number:

R318

Yu Hai-long, Liu Jun, Chen Yu, Wang Hong-wei, Wang Qi, Ma Jun-xiong, Ren Wei-jian, Meng Ling-zhi, Xiang Liang-bi . Application of pedical screw visualization technique in screw placement of lumbar vertebrae fracture [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 547-552.

Figures/Tables 3

2.1 参与者数量分析按意向性分析，纳入32例单一节段腰椎骨折患者，均进行有效随访，全部进入结果分析，无脱落。 2.2 椎弓根螺钉可视化技术对腰椎骨折伤椎置钉患者知情同意满意度的影响通过椎弓根螺钉可视化技术，可以生动形象地向患者交代置钉方式、固定节段等相关的解剖学知识，通过图像向患者讲述可能出现的风险，比如术中由于脊柱严重畸形导致解剖结构复杂，可能会出现螺钉位置误置导致神经损伤，医生可以通过虚拟系统进行演示向患者讲述螺钉向椎管内置入损伤脊髓进而引起神经损伤，这样的术前告知便于患者及家属的理解，使其切实做到知情同意，本组患者的知情同意评分为非常满意的患者占100%。 2.3 椎弓根螺钉可视化技术对腰椎骨折伤椎置钉方式及内植物选择的影响通过椎弓根螺钉的可视化技术，可以利用计算机辅助手术规划技术，利用获得的医学影像数据在计算机上建立患体的三维数字模型，进而制定最佳置钉方案。通过椎弓根螺钉的可视化技术，可以在术前拟置钉椎体的椎弓根做详细评估，尤其是对观察伤椎椎弓根的完整性上起着非常重要的作用，通过此技术作者判断出10例患者的伤椎单侧完好，但是另一侧破坏严重，无法置钉，这就为置钉方式选择提供了有力参考，节省了置钉时间。本组应用椎弓根螺钉可视化技术术前测量制定最优化参数如置钉的水平面、矢状面角度、螺钉的长度，术中按照术前计划进行螺钉置入，如图1测量的长度为33 mm，医师可选择35 mm×6.5 mm的短椎弓根螺钉置入伤椎，根据测量的角度将合适的椎弓根螺钉置入伤椎内，从而保证不会因椎弓根螺钉过长而影响骨折块的复位情况以及增加手术风险，显著提高了螺钉置入的准确性，本组中置钉后CT平扫螺钉完全位于椎弓根内的比例为95.1%。"

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