本文選題：寰樞椎 + 椎弓根螺釘��； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:探討導(dǎo)航模板輔助寰樞椎椎弓根置釘?shù)臏?zhǔn)確性與臨床應(yīng)用的可行性,為臨床寰樞椎椎弓根置釘提供參考。方法:收集我院脊柱外科病區(qū)自2014年12月至2016年12月期間收治的寰樞椎骨折和或脫位行后路椎弓根固定患者的臨床資料,按照納入與排除標(biāo)準(zhǔn)的要求共24例患者納入本次研究,根據(jù)隨機(jī)分組的原則將入組患者分為實(shí)驗(yàn)組與對照組,其中實(shí)驗(yàn)組12例行導(dǎo)航模板輔助置釘,對照組12例行徒手置釘。1.對兩組患者常規(guī)行術(shù)后CT掃描,使用S.Kaneyama法評價(jià)兩組患者的置釘準(zhǔn)確性,并作統(tǒng)計(jì)學(xué)評價(jià);2.記錄兩組患者手術(shù)時(shí)間、術(shù)中出血量及透視次數(shù),并作統(tǒng)計(jì)學(xué)評價(jià);3.記錄兩組患者術(shù)前JOA、VAS評分,同時(shí)隨訪兩組患者術(shù)后半年JOA、VAS評分,并作統(tǒng)計(jì)學(xué)評價(jià)。結(jié)果:1.實(shí)驗(yàn)組12例患者共置入寰樞椎椎弓根螺釘48枚,其中0級48枚、Ⅰ級0枚、Ⅱ級0枚、Ⅲ級0枚,置釘滿意度(0級與Ⅰ級螺釘被認(rèn)為是置釘滿意螺釘)為100㳠;對照組12例患者共置入寰樞椎椎弓根螺釘螺釘48枚,其中0級34枚、Ⅰ級11枚、Ⅱ級3枚、Ⅲ級0枚,置釘滿意度為93.75㳠。兩組患者的置釘準(zhǔn)確性具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01)。2.實(shí)驗(yàn)組與對照組的平均手術(shù)時(shí)間分別是147.35±32.90min、171.40±34.12min,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);平均術(shù)中透視次數(shù)分別是2.05±0.81次、5.45±1.39次,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);平均出血量分別是331.10±83.71ml、372.15±75.46ml,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01)。3.實(shí)驗(yàn)組患者術(shù)前、術(shù)后半年JOA評分分別為11.91±3.12、15.31±1.12,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);對照組術(shù)前、術(shù)后半年JOA評分分別為12.13±2.32、15.45±0.98,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);兩組患者術(shù)前及術(shù)后半年JOA評分均無統(tǒng)計(jì)學(xué)差異(P㧐0.05)。4.實(shí)驗(yàn)組患者術(shù)前、術(shù)后半年VAS評分分別為5.76±1.42、1.91±0.72,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);對照組術(shù)前、術(shù)后半年VAS評分分別為5.61±1.57、2.05±0.68,具有顯著性統(tǒng)計(jì)學(xué)差異(P㩳0.01);兩組患者術(shù)前及術(shù)后半年VAS評分均無統(tǒng)計(jì)學(xué)差異(P㧐0.05)。結(jié)論:與傳統(tǒng)徒手寰樞椎椎弓根置釘相比:1.導(dǎo)航模板可以顯著提高置釘?shù)臏?zhǔn)確性;2.導(dǎo)航模板可以顯著減少手術(shù)時(shí)間、術(shù)中透視次數(shù)及出血量;3.導(dǎo)航模板在手術(shù)前后JOA、VAS評分改善情況方面與徒手置釘相當(dāng)。導(dǎo)航模板輔助寰樞椎椎弓根置釘具有較大使用價(jià)值,臨床可行性高。
[Abstract]:Objective: to explore the accuracy and clinical feasibility of using navigation template to assist atlantoaxial pedicle screw insertion, and to provide reference for clinical atlantoaxial pedicle screw insertion. Methods: the clinical data of patients with atlantoaxial fracture and dislocation treated by posterior pedicle fixation from December 2014 to December 2016 were collected. 24 patients were included in the study according to the criteria of inclusion and exclusion. According to the principle of random grouping, the patients were divided into experimental group and control group. The experimental group (12 cases) was treated with navigation template and the control group (12 cases) with unarmed nail. S.Kaneyama method was used to evaluate the accuracy of nail placement in the two groups, and statistical evaluation was made to evaluate the accuracy of the two groups. The time of operation, the amount of blood loss and the times of fluoroscopy were recorded and evaluated statistically. The preoperative JOAA VAS scores were recorded in both groups, and the JOAA VAS scores were evaluated at half a year after operation in both groups. The result is 1: 1. In the experimental group, 48 pedicle screws of atlantoaxial pedicle were implanted in 12 patients. Among them, 48 were in grade 0, 0 in grade 鈪，

本文編號：1812791