胸椎椎弓根螺钉置入位置的CT评价

Evaluation of thoracic pedicle screw placement position by computed tomography

目的:探讨胸椎椎弓根螺钉置入的准确性和安全性。方法:对37例胸椎椎弓根螺钉内固定患者术后行CT断层扫描,观察螺钉在椎弓根内的位置,记录螺钉穿透骨壁的位置、数目和距离。结果:37例患者共置入405枚胸椎椎弓根螺钉,124枚螺钉(30.61%)穿透骨壁,其中76枚(18.77%)穿透椎弓根外侧壁,32枚(7.90%)穿透椎弓根内侧壁,16枚(3.95%)穿透椎体前壁。66枚(16.30%)穿透距离<2mm,37枚(9.14%)穿透距离在2mm^4mm之间,21枚(5.9%)穿透距离>4mm。结论:胸椎椎弓根螺钉骨壁穿透率较高,应严格按照胸椎椎弓根螺钉置入方法,仔细操作,避免出现因螺钉置入不当造成神经、血管或内脏损伤等并发症。

Objective:To evaluate the accuracy of thoracic pedicle screw placement by computed tomography.Method:Thoracic pedicle screws were inserted in 37 patients subjected to thoracic pedicle screw fixation,and postoperative computed tomography(CT) were scanned to determine the screw position,cortical perforation number and distance.Result:A total of 405 thoracic pedicle screws were inserted,in which 124 screws(30.61%) violated the pedicle wall.76 screws(18.77%) violated the pedicles lateral wall,32 screws(7.90%) violated the medial wall,and 16 screws(3.95%) violated the vertebral anterior wall happened respectively.Furthermore,perforated distance of 66 screws(16.30%) were less than 2mm,37 screws(9.14%) ranged 2mm^4mm,and 21 screws(5.9%) were beyond 4mm.Conclusion:Although thoracic pedicle screw violated pedicle wall happened frequently,thoracic pedicle screw could be inserted safely and accurately without neurologic,vascular or visceral complications if strictly according to the screw placement technique.