| Objective: The spinal deformity correction surgery uses two different auxiliary screw placement methods : 3D printing navigation template and orthopedic navigation robot.The clinical efficacy and correction effect of the two methods are compared.The factors affecting the accuracy of screw placement and screw placement skills are discussed.The advantages and disadvantages of the two auxiliary screw placement methods in spinal correction are compared,which provides a reference for the selection of screw placement methods in orthopedic surgery for spinal deformity.Methods: A retrospective study was conducted to select the clinical data of patients diagnosed with spinal deformity in the Department of Spinal Surgery of Gansu Provincial People ’s Hospital from March 2016 to December 2022.According to the different methods of assisted screw placement,they were divided into 3D printing navigation template group and orthopedic navigation robot group.The 3D printing navigation template group included21 patients,including 9 males and 12 females,with an average age of(37.38±20.53)years and an average follow-up of(14.19±1.47)months.A total of 20 patients were included in the orthopedic navigation robot group,including 8 males and 12 females,with an average age of(35.65±19.01)years and an average follow-up of(14.05±1.36)months.Collect and record perioperative indicators: including operation time,screw placement time,intraoperative blood loss,postoperative drainage volume,preoperative and postoperative height,intraoperative Carm fluoroscopy times,preoperative waiting days,hospitalization days,cost situation,complications.The visual analog scale(VAS)and Oswestry disability index(ODI)were used to compare the surgical outcomes before operation,3 months and 12 months after operation.Imaging indicators : The Cobb angle of scoliosis or kyphosis before and after operation was recorded.The correction level after operation was compared and the deformity correction rate was calculated.Postoperative CT scan of the surgical segment was completed,and the screws were classified according to the Gertzbein-Robbins standard,and the accuracy of screw placement was calculated.SPSS 26.0 was used for statistical analysis,and P<0.05 was considered statistically significant.Results:There was no significant difference in general data,preoperative height,preoperative Cobb angle and postoperative follow-up time between the two groups(P>0.05).The operation time of the 3D printing navigation template group and the orthopedic robot group was(251.67±36.69)min and(286.25±46.34)min.The screw placement time was(45.05±11.90)min and(55.88±14.10)min.The preoperative waiting days were 7.00(6.00,8.00)d and 3.00(3.00,4.00)d.The hospitalization days were(21.90±2.21)d and(19.20±1.54)d.The consumables cost were 3000(2000,3125)yuan and 8000(8000,8000)yuan.The VAS score and ODI index of the two groups were significantly improved at 3months and 12 months after operation(P<0.05);there was no significant difference in VAS score and ODI index between the two groups before operation,3 months after operation and12 months after operation(P>0.05).In terms of orthopedic effect,the postoperative height growth of the two groups was(10.52±1.99)cm and(11.20±1.70)cm,the scoliosis correction rate was(67.33±3.74)% and(65.73±5.12)%,and the kyphosis correction rate was(67.84±3.58)% and(64.18±3.63)%,respectively,which were significantly improved compared with those before operation(P<0.05);there was no significant difference between the two groups(P> 0.05).The accuracy of screw placement in the 3D printing navigation template group was 94.8%,and the accuracy of type A screw placement was 78.7%;the accuracy of screw placement in the orthopedic navigation robot group was 96.7%,and the accuracy of type A screw placement was 86.0%;there was no significant difference between the two groups(P>0.05),the accuracy of type A screw placement in the orthopedic navigation robot group was higher than that in the 3D printing navigation template group(P<0.05).In the 3D printing navigation template group,the accuracy of thoracic and lumbar screw placement was 91.9% and 97.8%,and the accuracy of type A screw placement was72.4% and 85.4%,there was no significant difference in the accuracy of thoracic and lumbar screw placement(P>0.05),the accuracy of type A screw placement in lumbar spine was higher than that in thoracic spine(P<0.05).In the orthopedic navigation robot group,the accuracy of thoracic and lumbar screw placement was 96.1% and 96.9%,and the accuracy of type A screw placement was 81.4% and 90.8%,there was no significant difference in the accuracy of thoracic and lumbar screw placement(P>0.05),the accuracy of type A screw placement in the lumbar spine was higher than that in the thoracic spine(P<0.05).In the 3D printing navigation template group,1 patient had superficial incision infection after operation,and the wound secretion was cultured as Staphylococcus aureus,sensitive antibiotics were selected and healed after strengthening dressing change;1 patient had abnormal nerve monitor after T5 right pedicle screw placement,and the screw position was adjusted in time,after the operation,the right lower limb weakness occurred,and the muscle strength was grade 2,after the operation,symptomatic treatment such as nutritional nerve,dehydration and swelling was actively given,the rehabilitation physician was consulted to assist in the diagnosis and treatment,the patient’s muscle strength returned to normal 2 month after the operation.In the orthopedic navigation robot group,1 patient had fat liquefaction in the surgical incision after operation,and the incision healed after strengthening dressing change;dural injury occurred in 1 patient during orthopedic surgery,and cerebrospinal fluid leakage occurred after surgery,after taking the foot high and head low,the drainage tube was prolonged and the drainage tube was removed after 1 week of continuous drainage.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion: Both 3D printing navigation template and orthopedic navigation robot assisted screw placement can improve the accuracy and safety of screw placement in the treatment of spinal deformity.In terms of operation time,screw placement time,the 3D printing navigation template has advantages over the orthopedic navigation robot;the orthopedic navigation robot has advantages in the accuracy of screw placement in type A screws;the 3D printing navigation template is superior to the orthopedic navigation robot in terms of cost,but it has no advantage in preoperative waiting days and hospitalization time.The factors affecting the accuracy of pedicle screw placement are related to the diameter of pedicle. |
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