CT扫描引导胸腰段椎弓根钉置入技术的临床研究

Clinical Observance of the Setting-Screw Technique on CT Scanning Lumbar Thoracic Pedicle

目的:探讨总结以术前CT扫描推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的改良置入方法。方法:以术前CT扫描确定推弓根轴心线,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棘突线得出,使用该改良置钉技术对77例脊柱患者置入胸腰段椎弓根螺钉312枚。结果:本组305枚螺钉术后均拍摄椎弓根CT,仅7枚穿破椎弓根皮质,失误率2.24%,但穿破均较小,均无神经根症状。238枚螺钉完全置入椎弓根。结论:术前CT扫描椎弓根引导胸腰段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。

Object： Discuss and summarize the improved seting--screw technique of the lumbar--thoracic pedicle on the preoperative CT scanning the pedicle axes. Methods： The improved seting-- screw technique of the lumbar-- thoracic pedicle was that the preoperative CT scanning confirmed on the pedicle axes. The screw seting position was obtained in consulting the anatomic symbol nearby the pedicle axes. The inter--incline angle （E--angle） and length and diameter of screw can be numerated in the CT scanning film of pedicle axe. The arrow--state angle（F --angle） Can be numerated in the lateral X - ray film of spine or educed in observing the line of spine process. The 56 cases of the thoracic--lumber vertebra （the 242 piece of the pedicle screws） were seting screw in the improved screw--seting technique. Results： After operation the pedicle of all case was rechecked in the CT scanning. The 305 piece of screws completely put in side the pedicles, only the 7 piece put out the cortex of the pedicle,the fault ratio was 2.24% ,but the destroy of the cortices was fairly small, and all the cortices-destroyed case hadn＇t the symptom of nerve root. Conclusion： The improved screw--seting technique of the lumber-- thoracic pedicle that refer to the anatomic symbol nearby the pedicle axes confirmed in the preoperative CT scanning is a better method,it can effectively descend the ratio of bad screw.