| Objective: In this study,we analyzed the morphological characteristics of the pedicle in the apical vertebral region of adolescent idiopathic scoliosis(AIS),and compared the accuracy and deviation direction of the same pedicle type in AIS patients pedicle type of AIS patients with navigation and navigation calibration techniques,so as to explore the related factors affecting the deviation of navigation screw placement and the clinical significance of intraoperative navigation calibration techniques and the relationship between the morphological characteristics of the pedicle in the apical vertebral region of AIS patients and the screw placement.Methods: From October 2017 to October 2021,a retrospective analysis was performed on 60 patients who were diagnosed with AIS and underwent navigation-assisted posterior scoliosis correction and internal fixation in our hospital.According to whether navigation calibration technology was used during operation,60 patients were divided into two groups : simple navigation group(n = 30)and navigation calibration group(n = 30).The basic information of the two groups of patients was collected,and the Risser sign,preoperative and postoperative Cobb angle and postoperative correction rate of the two groups were recorded.The pedicles of the apical vertebrae of the two groups were classified according to the Fu Changfeng pedicle classification system before operation,and the accuracy and deviation of the same type of pedicle screw placement in the two groups were evaluated according to the Rao classification.Results: A total of 600 different types of pedicles were counted in the apical vertebral area of the two groups,300 in the navigation group and 300 in the navigation calibration group.There was no significant difference in the distribution rate of A,B,C,D and E pedicles between the two groups(P > 0.05).However,the abnormal pedicle distribution rates of the simple navigation group and the navigation calibration group were 67.0 % and 67.7 %,respectively,which were significantly higher than 33.0 % and32.3 % of the normal pedicle.At the same time,the abnormal pedicle distribution rates of the concave side in the two groups were 74.7 % and 72.7 %,which were significantly higher than 25.3 % and 27.3 % of the normal pedicle(P < 0.05).In addition,a total of583 pedicle screws were placed between the two groups,including 294 in the navigation group and 289 in the navigation calibration group.The excellent and good rates of type A and B pedicle screw placement in the navigation calibration group were95.9 % and 93.7 %,which were significantly higher than those in the simple navigation group(83.8 % and 76.2 %).At the same time,the excellent and good rates of type B and C pedicle screw placement in the navigation calibration group were 92.2 % and83.3 %,which were significantly higher than those in the navigation group(71.9 %and 54.4 %)(P < 0.05).At the same time,the rate of pedicle lateral cortical rupture of type A,B and C in the navigation calibration group was 0.0 %,3.2 % and 9.8 %,which was significantly lower than 16.2 %,13.1 % and 42.9 % in the simple navigation group(P < 0.05).The perforation rates of type B and type C pedicles and their concave medial cortex in the navigation calibration group were 2.4 %,7.8 % and 6.7 %,respectively,which were significantly lower than those in the simple navigation group(16.9 %,20.4 % and 24.2 %,respectively)(P < 0.05).No serious complications such as spinal cord,neurovascular injury occurred between the two groups.Conclusion: There are obvious stenosis and deformity of the pedicle in the apical vertebral region of AIS patients,and intraoperative navigation can effectively prevent navigation deviation after real-time calibration,significantly improve the accuracy of normal pedicle(type A)and partial abnormal pedicle(type B,C)screw placement in the apical vertebral region of AIS patients,reduce the rate of wall rupture of the inner and outer cortex of the misplaced screw,and improve the safety of the operation. |
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