| Scoliosis orthopedics has always been the most difficult surgery to spine surgeons,which was regarded as “cutting-edge” in spinal field.The characteristics of spinel deformity are diverse etiology and various types.The age is widely dispersed,which make the treatments of scoliosis changeable and individual.A lot of spine surgeon are unable to complete this operation.In recent 10 years,pedicle screw system is widely used and Multistage osteotomy technology is popularized.The posterior three-dimensional orthopaedic surgery has made unprecedented progress.The accurate placement of pedicle screws is the precondition of achieving satisfactory outcome.But these patients usually combine vertebral rotation and deformity,the accuracy is greatly reduced,which lead to some irreversible damages and even paralysis.In order to improve the accuracy of pedicle screw placement for patients with spine deformity,reduce nerve vascular and visceral injury and improve the success rate of surgery,a variety of spinal navigation systems have been researched and developed,combining neural electrophysiological detection,computer aided navigation with three-dimensional reconstruction by intraoperative CT scan,Mazor robotic system,electronic navigation based on electrical impedance of vertebra and so on.With the spinal navigation system which became the umbrella of "high-level" surgery,we can improve the accuracy of nailing,shorten the operation time and reduce the postoperative complications.Objective: In the earlier stage,we completed the theoretical study of Mazor robotic system and electronic navigation system.At the same time,We acquired how to use it.The placement of pedicle screws for patients with scoliosis can be carried out under the protections of these two navigation system.The average time of pedicle screw instruments,the accuracy and radiation quantity can be collected for statistical analysis,which can verity the safety and practicability of navigations.To spine deformity,These systems can provide security guarantee.Methods: Part one.Application of the spine robot navigation for pedicle screws in scoliosis.First of all,we have to be familiar with the robot operating system and surgical indications,including preoperative planning,fixed platform,3 D matching,operation,with cadaver training.Secondly,collecting scoliosis patients and improve the imaging examination.What’s more,Implanting pedicle screws with robot navigation,collecting the number of pedicle screws,average number of shot,perforation rate after CT scan.Calculating the accuracy and security of Renaissance system by data analysis.Part two.Application of electronic navigation based on electrical impedance of vertebra for pedicle screws in scoliosis: First of all,Being familiar with the design principle and using skills.Then gathering patients with spine deformity and divided into two groups by random,the 2 groups were compared for accuracy of screw placement in apical area,time for screw placement and the number of times the C-arm had to be brought into the field.At last,Sorting data and analyzing clinical advantages and disadvantages of electronic conductivity device.Results:Part 1.A total of 26 patients with adolescent idiopathic scoliosis(AIS)were brought into these research:Male 4 and female 22,average main cob angle(68.8 + 7.2)°,221 pedicle screws were inserted by robot navigation.It took(3.3±0.9)min to implant an screw averagely,(1.5±0.7)times for matching.C-arm machine were taken in(9.6±2.5)times.It toke about(20.3±5.6)min on average for matching(fixing platform+3D restruction).The accuracy of pedicle screws is about 96.8%(214/221)after CT scan.Part 2.All the patients had a successful operation without any clinical complication.A total of 48 patients with adolescent idiopathic scoliosis(AIS)were brought into these research:Male 7 and female 41,average main cobb angle(58.3 + 9.0)°,161 pedicle screws were inserted by electronic conductivity navigation(ECN),the accuracy of pedicle screws is about 97.5%(157/161).158 pedicle screws were inserted by free-hand technology(FHT),the accuracy of pedicle screws is about 93.0%(147/158).The average radiation quantity: ECN group were(3.3±0.7)times and FHT group were(5.5±0.8)times.The average time of screws placement in apical area: ECN group was(2.7±0.4)min,with(3.2±0.6)min in FHT group.The average radiation quantity: ECN group were(3.3±0.7)times and FHT group were(5.5±0.8)times.Conclusion:Spine deformity is complicated,it exist vertebral rotation in coronal,sagittal and transversal position.The placement of pedicle screws depend entirely on the performer’s experience and three-dimensional imagination.Robot navigation technology can provide a preoperative 3D restruction before operation to guide pedicle screws insertion,which decrease screws perforation rate.Electronic conductivity navigation can transform the impedance of the different organizations into sound and frequency information,by which surgeons can choose the best channel for placements,reducing the misplacement of screws,at the same time reducing the electric radiation for doctors and patients. |
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