CT三维重建在特发性脊柱侧弯椎弓根个体化置钉中的作用研究

Individual pedicle screw placement for idiopathic scoliosis guided by CT reconstruction

目的:探讨螺旋CT三维重建技术指导特发性脊柱侧弯胸腰椎椎弓根个体化置钉的新方法。方法:徒手置钉组和重建指导组各20例患者,重建指导组术前CT扫描及三维重建得出置钉点以及该点的进钉角度参数,术中用所得重建点以及自行研制的外展角导向器指导置钉;徒手置钉组用Lenke所提出的徒手技术置钉。术后用CT平扫比较两种方法置钉的准确率。结果:两组共分别置入椎弓根钉330枚和333枚,准确率分别为86.4%和94.3%,重建指导组的准确率明显高于徒手置钉组(P=0.01)。结论:术前对脊柱的CT扫描和三维重建,能够为每一个椎体椎弓根提供精确置钉点及置钉方向,显著提高脊柱侧凸胸腰椎椎弓根螺钉置钉的准确率。

Objective： To investigate the efficacy of CT 3D reconstruction on the guidance of pedicle screws placement for idiopathic scoliosis. Methods： 40 patients with idiopathic scoliosis were randomly divided into reconstruction group and free hand group. Operation was conducted in reconstruction group with the guidance of entry point and transverse angle established by CT reconstruction. Patients in free hand group underwent pedicle screws placement with the guide of free hand technique proposed by Lenke. CT scan was used to evaluate the accuracy of screw position. Results： 330 and 333 screws were placed in patients of two groups, respectively, with the accuracy of 86.4% and 94.3%. Higher accuracy presented itself in reconstruction group （P=-0.01）. Conclusions： Preoperatively CT scan with 3D reconstruction could provide individual entry point and transverse angle for each pedicle, and subsequently, improve the accuracy of placement in scoliosis.