Comparison Of The Clinical Effect Of Two-Dimensional Computer Navigation Assisted And Traditional Fluoroscopy In Thoracolumbar Pedicle Screw Placements

Objective:To compare the clinical effects of two-dimensional computer-assisted fluoroscopy and conventional C-arm fluoroscopy in thoracolumbar pedicle screw fixation,in order to analyze the advantages and disadvantages of two-dimensional computer navigation in the clinical application of thoracolumbar screw fixation.Methods:The clinical data of 88 patients with thoracolumbar diseases treated with pedicle screw fixation from September 2019 to September 2020 in the Department of Traumatic Surgery of Fujian Provincial Hospital were analyzed retrospectively by Case-control study,there were 50 cases of thoracolumbar fracture,23 cases of lumbar disc protrusion,9 cases of lumbar spinal stenosis and 6 cases of lumbar spondylolisthesis.According to different operation methods,55 cases of conventional C-arm fluoroscopy and 33 cases of two-dimensional computer-assisted fluoroscopy were divided into two groups.The operation time,intraoperative bleeding,incision length,postoperative drainage,length of stay,accuracy of screw placement and postoperative complications were analyzed.Results:The mean time of operation was 182.6±58.3 min in fluoroscopy group and209.4±49.9 min in navigation group,P=0.031<0.05,There was significant difference between the two groups.The mean value of intraoperative bleeding was 187.3±146.5 ml in fluoroscopy group and 224.2±150.5 ml in navigation group,P =0.260>0.05,There was no significant difference between the two groups.The average length of incision was9.6±2.5 cm in fluoroscopy group and 10.7±2.9 cm in navigation group,P=0.062>0.05,There was no significant difference between the two groups.The mean drainage volume of fluoroscopy group was 179.5±108.6 ml,and that of navigation group was 168.0±111.2 ml,p=0.688>0.05.There was no significant difference between them.The average length of hospitalization in fluoroscopy group was 10.6±8.9 days,and that in navigation group was 13.2±5.3 days,p=0.128>0.05.There was no significant difference between the two groups.There were 9 cases in fluoroscopy group and 5 cases in navigation group,P=0.880>0.05.There was no significant difference between them.In the perspective group,the angle between the axis of the right pedicle and the upper vertebral endplate(α angle)averaged 4.5°±1.3°,and that of the left side averaged4.2°±1.1°.In the navigation group,the angle between the axis of the right pedicle of vertebral arch and the upper endplate(α angle)was 3.2°±0.6°,and that of the left side(αangle)was 3.8°±0.4°.The angle of intersection(β angle)of bilateral pedicle screw axis in fluoroscopy group was 3.12°±1.3° greater than that in navigation group(1.9°±0.3°)(p=0.023<0.05).The accuracy rate of the fluoroscopy group was85.8%,which was lower than that of the navigation group(92.6%),P=0.036<0.05.The difference was statistically significant.Conclusion:Two-dimensional computer aided navigation is superior to conventional C-arm fluoroscopy in the accuracy of nail insertion,which can improve the accuracy of nail insertion.However,the operation time of the navigation group is often more than that of the perspective group.We think that it is mainly due to the shortcomings of the navigation system itself,such as the equipment preparation and proofreading time,intraoperative occlusion,in addition,it is also related to the experience of the operator and the cooperation degree of the assistant,and there is a certain learning curve in the navigation assisted operation.There was no significant difference between the two-dimensional computer navigation group and the conventional C-arm fluoroscopy group in the amount of intraoperative bleeding,incision length,postoperative drainage,length of stay and postoperative complications.Generally speaking,the two-dimensional computer navigation system plays an active role in thoracolumbar pedicle screw fixation,which is worth popularizing.