Objective To investigate the application value of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients. Methods Between October 2009 and December 2011, 46 patients with scoliosis were treated with thoracic pedicle screw placement under intraoperative CT navigation in 21 cases (group A) or under C-arm fluoroscopy in 25 cases (group B). There was no significant difference in age, gender, type of scoliosis, involved segment, and Cobb angle of main thoracic curve between 2 groups (P gt; 0.05). A total of 273 thoracic pedicle screws were placed in group A and 308 screws in group B. The pedicle screw position evaluated and classified by intraoperative CT images according to the Modi et al. method; and the accurate rate, the safe rate, and the potential risk rate of pedicle screws were calculated on the upper thoracic spine (T1-4), the middle thoracic spine (T5-8), the lower thoracic spine (T9-12), and the entire thoracic spine (T1-12). The accuracy and security of thoracic pedicle screw placement were compared between 2 groups. Results On the entire thoracic spine, the accurate rate of group A (93.4%) was significantly higher than that of group B (83.8%), the safe rate of group A (98.9%) was significantly higher than that of group B (92.5%), showing significant differences between 2 groups (P lt; 0.05). However, the potential risk rate of group B (7.5%) was significantly higher than that of group A (1.1%) (P lt; 0.05). On the upper, the middle, and the lower thoracic spines, there was no significant difference in the accurate rate, the safe rate, and the potential risk rate of pedicle screws between 2 groups (P gt; 0.05). According to CT evaluation results, the potential risk pedicle screws were revised or removed during operation. The patients of 2 groups had no neurological deficits through physical examination of nervous system at 3 days after operation. Conclusion Intraoperative CT navigation can improve the accuracy and security of posterior thoracic pedicle screw placement and it can ensure the safety of operation by finding and promptly removing or revising the potential risk pedicle screws.
目的 探讨CT导航下经皮骶髂螺钉固定技术治疗骨盆环损伤的安全性及临床疗效。 方法 对2009年1月－2011年3月期间我科收治的16例骨盆后环骨折脱位患者资料进行回顾性分析，所有患者均在计算机导航系统辅助下采用经皮骶髂螺钉固定技术进行治疗。 结果 16例患者骶1平面共植入18枚骶髂螺钉，其中14例单侧植入1枚螺钉。14例患者获得随访，随访时间14～49个月，平均19个月。根据Majeed临床效果评定标准：满意8例，良好5例，差1例。所有随访患者均无神经、血管损伤、骶髂螺钉松动、断裂等并发症。 结论 经皮骶髂螺钉固定技术是恢复骨盆后环稳定性的一种安全、有效的方法，具有创伤小、临床效果好、并发症少、手术操作简便、性价比高等优势，值得临床推广。