术前CT引导胸腰椎椎弓根螺钉置入改良技术

Improved setting-screw technique of lumbar-thoracic pedicle by guiding of the preoperative CT scanning

目的:探讨总结以术前CT扫描椎弓根轴心来获得螺钉置入解剖参数引导胸腰段椎弓根螺钉置入的改良方法。方法:使用改良置钉技术对56例脊柱损伤患者置入胸腰椎弓根螺钉242枚,其中男32例,女24例;年龄21～69岁,平均43岁。以术前CT扫描确定椎弓根轴心线,轴心线附近的解剖标志为参照确定螺钉入点,内聚E角、螺钉长度、直径均可在CT椎弓根轴心片上读出,而矢状F角可由X线侧位片上读出或观察脊突线得出。结果:242枚螺钉术后均拍摄椎弓根CT片复查,238枚螺钉完全置入椎弓根内,仅4枚有穿破椎弓根皮质,失误率1.65%,但穿破较小,均无神经根症状。结论:术前CT扫描椎弓根引导胸腰椎椎弓根螺钉的置入是一个较好的改良方法,能有效降低不良置钉率。

Objective ：To discuss and summarize the improved setting-screw technique of the lumbarthoracic pedicle on the preoperative CT scanning the pedicle axes. Methods： Fifty-six patients with spinal injury were studied,including 32 male and 24 female with the average age of 43 years ranging from 21 to 69 years. Two hundreds and forty-two pieces of the pedicle screws of the thoracic-lumber vertebra were inserted by the improved screw-setting technique. The pedicle axes were located by the preoperative CT scanning. The screw setting position was obtained by the anatomic symbol nearby the pedicle axes. The inter-incline angle （E-angle） and length and diameter of screw were numerated in the CT scanning film of pedicle axes. The arrow-state angle （F-angle） was numerated in the lateral X-ray film of spine or educed in observing the line of spine process. Resuits：After operation the pedicle of all case was rechecked in CT scanning. Two hundreds and thirty-eight pieces of screws were completely inserted inside the pedicles,only 4 pieces were inserted out of the cortex of the pedicle. The fault ratio was 1.65% ,but the destroy of the cortices were fairly small,and no symptom of nerve root happened. Conclusion ：The improved screw-setting technique of the lumber-thoracic pedicle by the preoperative CT scanning is a good method,it can effectively descend the ratio of bad screw.