C型臂与G型臂激光定位透视对无神经症状腰椎骨折经皮椎弓根螺钉置入的有效性和安全性比较

Comparison of the efficacy and safety of laser-guided C-arm versus G-arm fluoroscopy for percutaneous pedicle screw placement in patients with lumbar fracture without neurological symptoms

摘要:

目的 探讨C型臂与G型臂激光定位透视对无神经症状的腰椎骨折经皮椎弓根螺钉置入的有效性和安全性。方法 选取2020年9月—2022年10月邢台市人民医院收治的96例无神经症状的腰椎骨折患者，以随机数字表法分为研究组和对照组，每组48例。研究组给予G型臂激光定位透视下经皮椎弓根螺钉置入，对照组给予C型臂激光定位透视下经皮椎弓根螺钉置入。术后随访6个月，对比两组手术及透视情况、疼痛、腰椎功能、腰椎解剖学参数情况，统计两组并发症发生情况。结果 研究组术中出血量少于对照组，手术时间、辐射曝光时间、透视操作时间短于对照组，辐射曝光次数少于对照组（P <0.05）。研究组透视精准率高于对照组（P <0.05）。研究组螺钉植入准确度等级高于对照组（P <0.05）。两组术前、术后1 d、术后3 d、术后1个月VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②两组VAS评分比较，差异无统计学意义（P >0.05）；③两组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。两组术前、术后6个月的JOA评分、ODI差值比较，差异均无统计学意义（P >0.05）。两组术前、术后6个月的伤椎前后缘高度比差值、后凸Cobb角差值、外旋活动度差值比较，差异均无统计学意义（P >0.05）。两组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 无神经症状的腰椎骨折患者C型臂与G型臂激光定位透视下行经皮椎弓根螺钉置入均可获得满意疗效，但G型臂激光定位透视可减少透视次数，缩短手术时间，且透视精准率、螺钉植入准确度更高。

Abstract:

Objective To explore the efficacy and safety of laser-guided C-arm and G-arm fluoroscopy for percutaneous pedicle screw placement in patients with lumbar fracture without neurological symptoms.Methods Ninety-six patients with lumbar fracture without neurological symptoms admitted to our hospital from September 2020 to October 2022 were selected and divided into the study group and the control group by random number table method, with 48 cases in each group. The study group was treated with percutaneous pedicle screw placement under laser-guided G-arm fluoroscopy, and the control group under laser-guided C-arm fluoroscopy. Postoperative follow-up was conducted for a duration of 6 months. The indicators related to surgery and fluoroscopy, pain, lumbar function and lumbar anatomical parameters were compared between the two groups, and the incidence of complications was recorded.Results Compared with the control group, the operative duration was shorter, intraoperative blood loss and the frequency of radiation exposure were lower, and the duration of radiation exposure and the fluoroscopy duration were shorter in the study group (P < 0.05). The accuracy of fluoroscopy in the study group was higher than that in the control group (P < 0.05). The accuracy of screw implantation in the study group was higher than that in the control group (P < 0.05). Comparison of Visual Analogue Scale (VAS) scores between the two groups before surgery, 1 day after surgery, 3 days after surgery and 1 month after surgery via repeated measures analysis of variance showed that there were differences in VAS scores among time points (P < 0.05), no difference in VAS scores between the two groups (P > 0.05), and no difference in the change trends of VAS scores between the two groups (P > 0.05). The differences of the Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index (ODI) before and 6 months after surgery were not significantly different between the two groups (P > 0.05). The differences of the anterior/posterior vertebral height ratio, Cobb Angle and range of motion for external rotation before and 6 months after surgery were also not significantly different between the two groups (P > 0.05). There was no significant difference in the overall incidence of complications between the two groups (P > 0.05).Conclusion Satisfactory therapeutic effects could be achieved in patients with lumbar fracture without neurological symptoms by percutaneous pedicle screw placement under laser-guided C-arm or G-arm fluoroscopy, but laser-guided G-arm fluoroscopy may reduce the frequency of fluoroscopy and shorten the operative duration with higher accuracy of fluoroscopy and screw implantation.