Comparative Study Of Three-dimensional Navigation System Assisted With The X-ray Of Thoracolumbar Pedicle Screw Fixation Techniques

The thesis mainly consists two parts:the literature review and the clinical research.There are two parts of the literature review.The first one introduced the history of the pedicle screw insertion in the lower thoracic and lumbar spine.It includes the anatomic basis,the development of spinal instrumentation,the basic technique of the pedicle screw fixation,the use of X-ray fluoroscopy,evoked potentials and computer assisted surgery in the pedicle screw insertion,the clinical prognosis,et al.The second one overviews the computer assisted orthopaedic surgery.It reviewed the rudiments, history,key techniques and instruments,classification,ascendancy and shortcoming of computer assisted surgery,and introduced clinical application of spinal computer assisted surgery.The clinical research is about a comparative study of of lower thoracic and lumbar spine pedicle screw fixation assisted by X-ray fluoroscopy and spinal navigation with the intra-operative 3D-imaging modality.Thirty-six patients with lumbar protrusion of intervertebral disc associated with stenosis,lumbar stenosis associated with degenerative spinal instability,lumbar spondylolisthesis,lumbar burst fracture,cerebral palsy with severe spinal deformaty were instrumented with pedicle screw system by spinal navigation with the intra-operative 3D-imaging modality(group A) or by X-ray fluoroscopy(group B).The position of pedicle screw was assessed by intra-operative 3D-imaging system.The excellent rate of pedicle screw position,mean time of pedicle screw implanted,operating time,blood loss,post-operative complication were compared.Results:The excellent rate of pedicle screw position was higher in group A than that in group B.The mean time of pedicle screw implanted,operating time and blood loss were lower in group A than that in group B.There was no post-operative complication in group A.Conclusion:With spinal navigation combined with the intra-operative 3D-imaging modality,implantation of pedicle screw is more simplified,more accurate,safer,and shorter time-consuming.