脊柱外科椎弓根螺钉植入常用方法及其临床应用课件.ppt

1、脊柱外科椎弓根螺钉植入常用方法及其临床应用脊柱外科椎弓根螺钉植入常用方法及其临床应用Superiority of Pedicle Screw Pedicle screw fixation has numerous advantages over other methods of spinal fixation11.Gaines RW.The use of pedicle-screw internal fixation for the operative treatment of spinal disorders.J Bone Joint Surg Am 2000,82-A(10):1458-7

2、6.PerforationPedicle screw perforation,with rates ranging from 3%-43%11.Belmont Jr PJ,Klemme WR,Robinson M,et al.Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities.Spine 2012;27:1558-66.Perforations can further lead tocomplications such as:1 Dural tear

3、nerve root injuries paraplegia Vascular injury Instrument failureComplications1.Suk S-I,Kim W-J,Lee S-M,et al.Thoracic pedicle screw fixation in spinal deformities:are they really safe?Spine 2001;26:2049-57.已有方法一：（NPF组）Free hand徒手开路，术中X线“C臂”透视开路当时无法测知是否突破价值百万人民币重约一吨置钉后检测，如有损伤亡羊补牢对医生和病人辐射量大接触术野增加感染需要

4、外接稳定电源已有方法二：计算机辅助术中三维CT重建红外线传输导航标记移动造成误差价值数百万人民币重约数吨术中或术前CT扫描，增加十几至几十分钟手术时间操作复杂学习曲线漫长已有方法三：脊髓监测等电生理方法碰触或者已经损伤神经才能知晓造价昂贵连接复杂需要专业电生理监测团队人员信号受声音、电磁场、环境等影响明显已有方法四：脊柱机器人手术Mazor Robotics system1.Workstation2.Planning Software3.Robotic DeviceRobot-assisted pedicle screw insertion for scoliosis:a report of

5、14 cases 148 screws were inserted by the robot-guided machine 2.4 min/per screw Coronal Cobb angle:50.1o to 12.8o Accuracy Rate:95.3%椎弓根螺钉开路电子导航椎弓根螺钉开路电子导航研究设计scoliosis curve between 40 and 80；body weight less than 80 kgPerforations Grade on CT scan Grade 0(no apparent violation of the pedicle)Grade

6、 1(4 mm or complete perforation of the pedicle),with Grades 1,2 and 3 representing“perforation”.1.Rao G,Brodke DS,Rondina M,et al.Inter-and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement.Spine 2003,28(22):252730.术中实际操作及模拟动画演示动画模拟演示实际术中操作ResultsThe

7、T1T3 upper thoracic vertebra(UT),T4T7 middle(MT),T8T10 lower(LT),T11-L2 thoracolumbar(TL),and L3-L5 lower lumbar vertebra(LL).Results07年最早动物实验研究的报道09年最早人尸体标本研究报道讨论讨论讨论The T1T3 upper thoracic vertebra(UT),T4T7 middle(MT),T8T10 lower(LT),T11-L2 thoracolumbar(TL),and L3-L5 lower lumbar vertebra(LL).ConclusionsConclusions与现有C臂机、计算机辅助CT成像红外线导航、脊髓监测仪、机器人等相比：l价格：百万/百元=104；重量：数吨/数克=106l可用于微创置钉l实时监测，即刻反馈l内置电池，无需外接电源l精准度更高 l操作简单，学习曲线短l科用于低年资脊柱外科医师带教l可手持用于野战脊柱外科手术中l对医患无辐射、无术野污染、无干扰、“声色”并茂 Conclusions应用椎弓根螺钉开路电子导航器进行脊柱畸形矫正手术前后X线片