多层螺旋CT三维重建技术辅助脊柱经椎弓根内固定手术

Multi-slice spiral CT image 3D reconstruction assisting pedicle screw placement in spinal surgery

目的研究多层螺旋CT三维重建技术辅助脊柱经椎弓根内固定手术的方法。方法对68例脊柱经椎弓根内固定手术患者行多层螺旋CT薄层扫描后进行容积重建（VR）及多平面重建（MPR）,据此进行辅助诊断、术前计划及个体化测量以指导手术,并在术后评估效果。结果多层螺旋CT三维重建技术辅助下置入椎弓根钉366枚,包括颈椎168枚,胸椎52枚,腰椎146枚。术后复查CT,20枚（5.46%）钉发生超过＂安全区域＂范围的椎弓根穿破,其中颈椎11枚（11/168）发生1～2mm的穿破,1枚（1/168）穿破外侧壁2.2mm,但未出现临床症状,胸椎1枚（1/52）、腰椎7枚（7/146）存在2～4mm的穿破。所有病例术后未发生与置钉相关的脊髓、神经、血管并发症。结论应用多层螺旋CT扫描三维重建辅助脊柱经椎弓根内固定手术,可以量化、个体化确定手术参考指标,提高手术的安全性和准确性。

Objective To study the method of MSCT image three-dimensional （3D） reconstruction technique assisting pedicle screw placement in spinal surgery. Methods Thin-slice volume scan by MSCT was performed in 68 patients with pedicle screw placement in spinal surgery, and then 3D image was reconstructed with VR and MPR techniques. The reconstructed 3D images were then utilized to improve accuracy of diagnosis and individualize measurements to guide spinal surgery and evaluate therapeutic effect. Results Three hundreds and sixty-six posterior pedicle screws were inserted assisting with MSCT image 3D reconstruction technique, including 168 cervical pedicle screws, 52 thoracic pedicle screws and 146 lumbar pedicle screws, respectively. Twenty （5. 46%） pedicle perforations, which located out of ＂definite safe zone＂ and might potentially cause the complication were determined by postoperative MSCT scan. In 168 cervical pedicle screws placement, 11 pedicle perforations of 1-2 mm were found, and 1 penetrated the lateral cortex 2.2 mm, but with no clinical sequela. One thoracic pedicle screws and 7 lumbar pedicle screws penetrated the pedicle cortex 2-4 mm, respectively. No postoperative damage to spinal cord or neurovascular structures related screw misplacement occurred in any cases. Cnnclusion With MSCT image 3D reconstruction techniques, the individual and quantifiable reference data can be obtained to assistthe spinal surgery of posterior pedicle screw placement. Based on these techniques, more reasonible preoperative plans can be designed and performed, and the safety and accuracy of the surgery can be improved.