Ho-Yeon Lee, Sang-Ho Lee, Hyeong Kweon Son, Jong Han Na, June Ho Lee, Oon Ki Baek, Chan Shik Shim
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引用次数: 16
Abstract
Objective: Multilevel Oblique Corpectomy (MOC) is an emerging technique for surgical treatment of multi-segmental cervical spondylotic myelopathy (CSM) featuring extensive ossification of the posterior longitudinal ligament (OPLL). However, the use of an oblique drilling plane is unfamiliar to most surgeons and there is no anatomical landmark present on the posterior portion of the vertebral body. To overcome these difficulties, the authors used intraoperative C-arm-based image guided navigation (IGN), and this study was conducted to evaluate the efficacy of IGN in MOC.
Methods: Following the introduction of IGN for MOC, 24 patients underwent MOC procedures at our institution. Two patients who had undergone previous cervical operations were excluded from the present study. Of the remaining 22 patients, 11 underwent MOC with IGN, and 11 underwent MOC without IGN support. The completeness of MOC (CMOC) is measured as the sum of the bilateral remaining posterior body minus the remaining approach-side anterior body in millimeters at the most compressive level. For each patient, the preoperative Japanese Orthopaedic Association Score (JOAS) and postoperative 5th day JOAS were collected as well as several other perioperative parameters.
Results: The mean CMOC was 0.89 mm for the IGN group and 5.9 mm for the control group. The mean change in JOAS was 5.58 for the IGN group and 3.34 for the control group at 1-year follow-up. In the control group, two patients underwent re-exploration due to remaining OPLL. Despite the intraoperative IGN set-up time, the mean operation time for the IGN group was shorter than that for the control group (248 min versus 259 min). Mean treated levels were 3.55 for the IGN group and 3.36 for the control group.
Conclusion: Through the use of image guided navigation, it was possible to accomplish faster and more complete MOC.
目的:多节段斜椎体切除术(MOC)是一种新兴的手术治疗以后纵韧带(OPLL)广泛骨化为特征的多节段脊髓型颈椎病(CSM)的技术。然而,斜钻孔平面的使用对大多数外科医生来说是陌生的,并且在椎体后部没有解剖标志。为了克服这些困难,作者采用术中基于c臂的图像引导导航(IGN),本研究评估IGN在MOC中的疗效。方法:引入IGN治疗MOC后,24例患者在我院接受了MOC手术。两名既往颈椎手术的患者被排除在本研究之外。在其余22例患者中,11例接受了有IGN支持的MOC, 11例接受了没有IGN支持的MOC。MOC的完整性(CMOC)测量为双侧剩余后体减去剩余入路侧前体在最大压缩水平的毫米之和。收集每位患者术前日本骨科协会评分(JOAS)和术后第5天JOAS以及其他围手术期参数。结果:IGN组平均CMOC为0.89 mm,对照组为5.9 mm。在1年的随访中,IGN组JOAS的平均变化为5.58,对照组为3.34。在对照组中,2例患者因OPLL残留而再次探查。尽管术中IGN设置时间较长,但IGN组的平均手术时间短于对照组(248 min vs 259 min)。IGN组的平均治疗水平为3.55,对照组为3.36。结论:通过图像引导导航,可以实现更快、更完整的MOC。
期刊介绍:
The scope of Computer Aided Surgery encompasses all fields within surgery, as well as biomedical imaging and instrumentation, and digital technology employed as an adjunct to imaging in diagnosis, therapeutics, and surgery. Topics featured include frameless as well as conventional stereotaxic procedures, surgery guided by ultrasound, image guided focal irradiation, robotic surgery, and other therapeutic interventions that are performed with the use of digital imaging technology.