图像存储传输系统多维测量在颈椎椎弓根内固定中的个体化应用

Individual Application of PACS Multi-dimensional Measurement in the Cervical Pedicle for Screw Placement

目的：探索利用图像存储传输系统（PACS）多维测量颈椎椎弓根64排CT片指导术中置钉，提高置钉一次成功率的效果。方法：应用PACS结合64排CT片，由5名医师对2000例正常人颈椎椎弓根的冠状位、矢状位及轴位进行精确测量，得出国人椎弓根的长度、宽度、高度及向内侧倾斜、向头、尾侧倾斜角度的数据值，以指导术中选钉及置钉。颈椎椎弓根内固定术前参考上述内容，对拟固定颈椎椎弓根的283例患者进行多维精确测量，得出椎弓根的上述数据值，其中上颈椎疾患91例，下颈椎疾患192例。术中应用自行研制的颈椎椎弓根定位导向器，准确定位人钉点及角度，置钉1198枚。结果：257例患者获得8～73个月随访，平均随访时间18．16个月。上颈椎患者3例螺钉穿破寰椎左侧椎弓根外侧壁，未发现脊髓、椎动脉损伤，未行二次手术，未发现钉板断裂，CT片示螺钉与椎动脉及脊髓位置关系良好。下颈椎患者中，16例患者17枚椎弓根螺钉术后拍片位置不理想，行二次手术调整位置满意，一次成功率98．58％。该组患者采用JOA评分标准，优132例，良102例，可18例，差5例，优良率91．05％。结论：应用PACS结合64排CT片术前三维精确测量，指导术中置入颈椎椎弓根螺钉，明显提高植钉的一次成功率，是一种可行的方法。

Objective：To study applying of the picture archiving communication system（following referred as PACS）in multi-dimensional measurement for 64-slice Helical CT films cervical pedicle,to guide pediele screws placement in intraoperation and improve the success rate of screw placing. Methods：Applying PACS combining with 64-slice Helical CT films to mersue accurately the cervical pedicle of 2 000 normal peoples in positions of coronal.sagittal and transverse,draw the datas of pedicle length,width and height, acquire the datas of angle to tilt the inside.head and caudal,and guide the selection of screw and set of screws in operation. From October 1999 to January 2009,there were 283 cases who had been putted 1 198 pedicle screw to treat the cervical spine disorders,including 91patients with upper cercical disease, 192 patients with lower cervical spine disorders. Reference to the above in preoperation, by multi-dimension, accurately measure the cervical pedicle fixed per patient. The above data values of cerciale pedicle were drawn, self-developed cervical pedicle positioning guider was applied and accurate positioning into the point and angle of screw were got. So the placement screws were 1 198,17 revised success and the success rate 98.58 %. Results： After operation, 257 patients were followed up for 8-73 months and average follow-up time was 18.16 months. Patients with upper cercical disease,lateral cortical bone of atlas vertebral pedicle was broken in 3 patients, but the spinal cord and vertebral artery were intact. Second operation was not done. CT film showed screws, vertebral artery and spinal cord lo- cation of relationship were good. For 16 patients with lower cervical spine patients, X-ray film of 17 pedicle screws after operation showed non-optimal location and underwent secondary surgical adjustment. Appliying JOA score standard, 132 cases were excellent, 102 cases good, 18 cases fair, 5 cases poor,and the excellent and good rate was 91.05 %. Conclusion： Application of PACS combining with 64-slice CT multi-dimensional accu- rate measurement in preoperation can guide placement of cervical pedicle screws in intraoperation excellently, and increase the success rate of cervical pedicle screws placement prominently. It is a viable approach worthy of promotion.