三维CT辅助颈椎椎弓根螺钉的置入

Three-dimensional computed tomography assisted cervical pedicle screw fixation

目的探讨三维CT在颈椎椎弓根螺钉置入手术中的应用。方法22例患者,其中男性14例,女性8例,年龄28～67岁(中位年龄46岁);9例为颈椎椎骨骨折,4例为颈椎肿瘤,6例为颈椎滑脱失稳,3例颈椎病。术前行SCT扫描三维重建,测量钉道的角度和安全范围,术中根据相关的数据选择螺钉,并进行个体化置钉,术后进行CT扫描,评估螺钉位置,计算每个螺钉置入的时间。结果导航下成功对22例患者共置入112枚颈椎椎弓根螺钉。术后CT椎弓根位置扫描:A级,104枚(92.8%);B级,5枚;C级,2枚;D级1枚。平均每枚螺钉置入的时间为9.3min(8～11min),术后临床无脊髓、神经和椎动脉损伤。结论在三维CT辅助下可以进行颈椎椎弓根个性化置钉,并能提高螺钉的准确性和效率。

Objective To study the application of three-dimensional computed tomography （3D CT） assisted cervical pedicle screw fixation in operation. Methods A total of 22 cases were performed cervical pedicle screw fixation of cervial spine,male 14, female 8,aged 28 - 67 years （median age 46 years）,including 9 patients with cervical spine fractures,4 cervical tumors,6 cervical destabilizing and 3 cervical syndrome. Preoperative 3D CT were performed by spiral CT （SCT）, measuring the angle and safe range of screw path,choosing screw and implanting screw individually by relative data. The cervical pedicle screw position were assessed with post-operative CT by grading. The time of screw implantation was calculated. Results A total of 112 screws were fixed in 22 cases successfully. The postoperative scanning of cervical vertebral pedicle position showed that 104 in grade A （92.8 %） ,5 in grade B ,2 in grade C, 1 in grade D.The average fixation time was 9.3 min （8 - 11 min） per screw.The damage of nerve and spinal cord and vertebral artery not found. Conclusion The 3D CT can assist implantation of cervical pedicle screw individually and improve precision and efficiency of screw fixation distinctively.