The Importance of Meticulous Registration during Spinal Navigation for Pedicle Screw Placement

精確定位於經椎莖骨釘植入導航手術之重要性

蘇豐文(Feng-Wen Su) ； 李道眞(Tao-Chen Lee) ； 呂鎭中(Chun-Chung Lui) ； 丁于齡(Yu-Ling Ting) ； 王宏振(Hung-Chen Wang) ； 林宥潤(Yu-Jun Lin) ； 蘇宗明(Thung-Ming Su)

《Formosan Journal of Surgery》 41卷1期 (2008/02) Pp. 1-6

https://doi.org/10.29833/FJS.200802.0001

摘要

註冊誤差爲手術解剖位置之電腦影像在脊椎導航手術中精確度的一個相對指標。本篇研究的目的在於探討註冊誤差對於經椎莖骨釘固定手術後骨釘植入位置之影響。
爲了研究註冊誤差與經椎莖骨釘固定手術後骨釘植入位置之相關性，我們分析了三十六位病人，共植入一百八十四支骨釘。記錄在脊椎導航手術過程中的註冊誤差數值，並以1.5公厘爲間距分爲二組一A組：註冊誤差低於1.5公厘：B組：註冊誤差高於1.5公厘。在術後以電腦斷層影像來評估骨釘植入位置之良作窳，並加以歸類。骨釘位於椎莖中央者評爲「佳」，稍有偏離而造成穿出椎莖表層2公厘以內者歸爲「尚可」，而超過2公厘以上者歸爲「差」。
在A、B兩組分別植入了94及90支骨釘。在A組中，75支(79.8%)骨釘被歸類爲「佳」，17支(18.1%)被歸類爲「尚可」，而2支(2.1%)爲「差」。在B組，57支(63.3%)骨釘被歸類爲「佳」，26支(28.9%)被歸類爲「尚可」，而7支(7.8%)爲「差」。結果經獨立t檢定分析後發現兩組在骨釘位置結果之差別達到統計學上顯著的意義(P=0.002)。根據本篇研究的結果，我們發現在脊椎導航手術時藉由控制註冊誤差可以改善經椎莖骨釘固定術之骨釘植入位置。

並列摘要

Objectives: To evaluate correlations between registration errors and accuracy of pedicle screw placement.
Methods: Registration errors were analyzed as a relative index of accuracy in the computer imaging of surgical anatomy during spinal navigation. One hundred eighty-four computer-assisted pedicle screw installations were performed in thirty-six patients. Registration errors during spinal navigation were recorded and grouped into A (registration error＜1.5mm) and B (registration error more than 1.5mm). The screw placements were evaluated by postoperative CT and were categorized as good (in the central core of the pedicle), fair (eccentricity of the screw and erosion of the pedicular cortex with perforation of less than 2mm), and poor (more than 2mm perforation).
Results: Ninety-four and ninety screw placements were examined in groups A (registration error＜1.5mm) and B (registration error more than 1.5mm), respectively. In group A, seventy-five (79.8%) pedicle screw placements were categorized as good, seventeen (18.1%) were fair, and two (2.1%) were poor. In group B, fifty-seven (63.3%) were good, twenty-six (28. 9%) were fair, and seven (7.8%) were poor. The difference in screw placement results between group A and Breached statistical signficance (P=0.002, independent samples t-test).
Conclusion: Significantly more accurate pedicle screw placement can be achieved by limiting registration errors.

並列關鍵字

spinal navigation ； pedicle screw placement ； registration error