CT三维重建立体导航引导技术在胸椎弓根钉置入手术中的应用

Three-dimensional CT reconstruction navigation for thoracic pedicle screw placement

目的探讨术前CT三维重建立体导航引导技术在胸椎弓根钉置入手术中的应用方法和临床意义。方法2003年5月-2006年5月采用CT三维重建导航对2t例（122枚）胸椎弓根钉置入手术进行立体引导，其中上胸椎38枚，中下胸椎84枚。男13例，女8例；年龄为13—76岁，平均43岁。术中使用C形臂X线机拍摄正侧位X线片，术后行CT扫描以了解椎弓根钉位置情况。结果术后CT椎弓根位置扫描显示：A级109枚（89．3％）B级6枚（4．9％）；C级3枚（2．5％）；D级4枚（3．3％）。结论术前CT三维重建立体导航引导技术使椎弓根钉按预期的路径精确置入，尤其提高了具有挑战性的胸椎椎弓钉置入的安全性和准确性。

Objective To explore the clinical application and outcomes of preoperative three-dimensional CT reconstruction navigation for thoracic pedicle screws placement. Methods From May 2003 to May 2006, 21 cases （ 13 males and 8 females, age ranged from 13 to 76 years old, average 43 years old） with 122 ihoracic pedicle screw placements guided by threedimensional CT reconstruction navigation were performed, including 38 in the upper thoracic vertebrae and 84 in the middle or lower thoracic vertebrae. Anteroposterior and lateral X-ray films were taken by C-arm X-ray machine during the operation. The pedicle screw position and involved vertebrae were routinely assessed with postoperative thin＇cut CT by an independent radiolo, gist. Results Pedicle breaches were graded A in 109 screws （89.3%）, B in 6 screws （419%）, C in 3 screws （2.5%）, and D in 4 screws （3.3%） according to postoperative CT Scan. Conclusion With the help of preoperative three-dimensional CT recostruction navigation, the surgeon can perform the screw insertion procedures confidently and accurately, and it is particularly a safe adjunct for technically challenging procedures such as thoracic pedicle screw placement.