Comparison Of Clinical Effect Between Computer Navigation-assisted And Manual Percutaneous Pedicle Screw Internal Fixation For Thoracolumbar Fracture

Objective: To evaluate the advantages and disadvantages of computer navigation in the treatment of thoracolumbar vertebral fractures by comparing the results of computer navigation assisted and bare hand percutaneous pedicle screw fixation.Methods:The medical records of patients with thoracolumbar fracture hospitalized in The Affiliated Hospital of Yan ’an University and spinal Surgery Department from January 2015 to January 2021 were collected and analyzed,and 60 patients,42 males and18 females,aged 24-58 years,were selected as eligible for inclusion and exclusion criteria.The patients were divided into two groups according to different surgical methods.Thirty patients were treated with percutaneous pedicle screw fixation under computer navigation,which was the navigation group.The remaining 30 patients were treated with barehanded percutaneous pedicle screw fixation.There was no statistically significant difference in general data between the two groups,indicating comparability.Operation time,blood loss,intraoperative radiation times,length of hospital stay and complications were compared between the two groups.All patients were followed up for more than one year,and Oswestry dysfunction index（ODI）was assessed at different stages before and after surgical treatment.Radiological evaluation was performed by measuring the anterior height of the injured vertebra and the kyphosis Cobb Angle of the injured vertebra at different stages before and after surgery.Accuracy of pedicle screw implantation was assessed by CT.Results:All patients were successfully operated and followed up for more than one year.The mean operation time,intraoperative blood loss and hospital stay in navigation group were（101.5±10.6）min,（47.8±15.1）ml and（12.6±1.9）days,respectively.The mean operation time,intraoperative blood loss and hospital stay in the unarmed group were（103.6±12.2）min,（54.3±19.4）ml and（12.0±1.8）days,respectively,and there was no significant difference between the two groups（P>0.05）.However,the number of intraoperative radiation was（5.5±1.0）times in the navigation group and（8.8±2.2）times in the unarmed group,and the difference between the two groups was statistically significant（P<0.05）.In the same treatment group,compared with before surgical treatment,ODI score,anterior height of injured vertebra and Cobb Angle of all patients were improved to some extent after surgery（P<0.05）,but there was no statistical significance between the two groups（P>0.05）.120 pedicle screws were implanted in each group.Postoperative CT evaluation showed that in the navigation group,101 type A screws,14 type B screws,and 5 type C screws were implanted.There were 88 type A screws,15 type B screws and 17 type C screws in the unarmed group.According to the evaluation criteria,the accuracy of nail implantation was 95.8% in the navigation group and 85.8% in the hands-free group,and the difference between the two groups was statistically significant（P<0.05）.Conclusion:1.Computer navigation-assisted percutaneous pedicle screw internal fixation and freehand percutaneous screw internal fixation are both minimally invasive operations with advantages of less trauma to patients,less intraoperative blood loss,shorter hospital stay,low incidence of complications and postoperative recovery.2.Compared with manual percutaneous pedicle screw fixation,the accuracy of screw implantation assisted by computer navigation system is significantly improved,and the number of intraoperative radiation is significantly reduced,which is worthy of wide application in clinic.