| Objective Pedicle screw fixation is an important surgical method for the treatment of lumbar diseases.But improper placement is still a common cause of surgical failure.Postoperative screw loosening remains the most common postoperative complication of this technique.Computer-assisted navigation technology has been successfully applied to pedicle screw insertion surgery.However,most lumbar navigation operations currently require additional incisions to fix the tracer on the spinous process of the patient.This paper aims to compared the accuracy and safety of accuracy and safety of lumbar pedicle screw placement of the navigation technique used to attach the patient tracer to the spinous process,and the navigation technique using a free arm to attach the patient tracer to the skin behind the spine,and the traditional C-arm X-ray machine assisted placement technique.And analyze the risk factors of screw loosening after.Methods Eighty-eight patients with lumbar disease undergoing pedicle screw fixation from January 2016 to March 2017 were divided into three groups based on the completion of surgical assistive techniques: 25 cases in the traditional group,pedicle screw placement was assisted by C-arm X-ray machine;22 cases in the spinous process fixed tracer navigation group(navigation group 1).The patient tracer of the navigation system was fixed on the spinous process of the patient and screw placement was completed with the assistance of intraoperative 3-D navigation technology.21 patients in the skin fixation tracer navigation group(navigation group 2).The patient tracer using a special free arm fixed to the skin surface,also in the intraoperative 3-dimensional navigation system assisted screw placement.The clinical and imaging data of each case were collected,and the mean time of screw placement,the number of intraoperative nail adjustments,the number of intraoperative ray exposures,and postoperative complications were recorded and calculated.The postoperative CT was selected to evaluate the placement of nails in the three groups of cases and compare the accuracy of the placement of the three groups of cases.According to X-ray and CT examination at 1 year after surgery to evaluate the situation of intervertebral fusion and screw loosening,and apply univariate and multivariate Logistic regression.Analyze and study the risk factors associated with the occurrence of postoperative screw loosening.Results There was no significant difference in the age,sex,bone density,disease type,body mass index,whether or not transdermal nail placement,and the use of universal nails among the three groups(P>0.05).The incidence of postoperative complications of screw loosening in the three groups was the highest,which was 24.0%,18.2%,and 14.3% respectively.The total incidence of 68 patients was 19.1%.In the number of intraoperative nail adjustments,the number of intraoperative radiographic exposures and the accuracy and safety rate of nail placement,navigation group 1 and navigation group 2 had obvious advantages over the traditional group(P <0.05),and there was no significant difference between the navigation group 1 and the navigation group 2(P>0.05).There was no statistical difference between the three groups in average screw placement time and interbody fusion and,and the incidence of screw loosening after one year(P>0.05).Analyzed one-year screw loosening occurred in 68 patients,univariate logistic regression analysis showed that there were significant changes in patient's age,bone mineral density,number of intraoperative nail-path adjustments,interbody fusion in postoperative screw loosening(P < 0.05).And there was no correlation between the occurrence of postoperative screw loosening on the respect of patient's gender,body mass index,whether or not to be nailed percutaneously,whether or not to use a universal nail,postoperative brace protection time,postoperative premature heavy activity,etc(P>0.05).Multivariate analysis showed that bone mineral density and number of intraoperative nail adjustments were independent risk factors for postoperative screw loosening.Conclusions Intraoperative three-dimensional navigation technology can significantly improve the accuracy and safety of lumbar pedicle screw placement and reduce the incidence of surgical complications;in this study,the method of fixing the patient's skin with a tracer does not reduce the accuracy of the navigation system and is worth further study.The bone mineral density and the number of intraoperative nail adjustments may be the main factors for the occurrence of postoperative screw loosening. |
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