多层螺旋CT对腰椎峡部裂手术治疗的指导价值研究

The study of pedicle imaging and reformation with the multi-slice spiral CT in the surgical treatment of lumbar spondylolisthesis

目的:探讨在多层螺旋CT(multislice spiral computerized tomography,MSCT)图像中测量的各种椎弓根参数对腰椎弓峡部裂手术治疗的指导价值。方法:自2009年1月至2010年3月,选择经保守治疗无效的腰椎峡部裂患者60例,男26例,女34例;年龄18～59岁,平均(42.60±9.36)岁。按随机数字表方法随机分成研究组和对照组,每组30例。研究组的患者术前均行MSCT容积扫描,并在工作站进行图像重组,在相应的图像中分别测量椎弓根水平位角(TSA)、椎弓根矢状位角(SSA)、椎弓根长度(PL)、椎弓根宽度(PW)、椎弓根高度(PH)等参数,术前根据已测得的椎弓根参数选择合适的椎弓根螺钉,术中根据所测参数并借助椎弓根角度定位器置入椎弓根螺钉。对照组则采用传统的解剖标志法结合术中透视定位置入椎弓根螺钉。术中分别记录每枚椎弓根螺钉钉道准备时间;术后复查MSCT,对椎弓根螺钉位置进行分级评估。比较两组间螺钉钉道准备时间及置入螺钉的准确率。结果:研究组置入椎弓根螺钉156枚,优143枚,良11枚,差2枚。对照组共置入椎弓根螺钉150枚,优101枚,良26枚,差23枚。两组螺钉位置的评估结果差异有统计学意义(P<0.001)。螺钉钉道准备时间研究组为(66.20±7.31)s,对照组为(104.11±9.51)s,两组时间差异有统计学意义(P<0.001)。结论:多层螺旋CT能为临床提供丰富的诊断信息及准确的参考数据。根据影像学资料所测得的参数能在术前制定更精确的手术方案,术中能既简便又准确地把握进钉方向,从而提高椎弓根螺钉置入的准确率,有效避免或减少手术并发症。

Objective ： To evaluate the value of pedicle parameter obtained by the reformation images on multi-slice spiral CT （MSCT） in the surgical treatment of lumbar spondylolisthesis. Methods：From January 2009 to March 2010,60 patients with lumbar spondylolisthesis failing in conservative treatment were enrolled into the study and divided into experimental and control group randomly （each group with 30 patients）. There were 26 males and 34 females ranging in age from 18 to 59 years with an average of（42.60±9.36）years. The experimental group was examined with volumetric scanning on MSCT before operation. Reformation such as multiplanar reconstruction （MPR） and volume rendering （VR） were carried out at the work station. Transverse section angle （TSA）,sagittal section angle （SSA）,pediele length （PL）,pedicle width （PW） and pediele height （PH） were measured on different images and pedicle screws were implanted according pedicle parameter. In control group,the pedicle screws were implanted according to conventional anatomic landmark. Preparative time of screw canal and accuracy of screw were compared between two groups. Results：A hundred fifty-six screws were inserted in experiment group, 143 screws were excellent, 11 good ,and 2 poor. A hundred fifty screws were inserted in control group, 101 screws were excellent ,26 good, and 23 poor. There was significant differece in accuracy of screw beween two groups （P〈0.001）.The preparative time of screw canal in experiment group was （66.20±7.31 ） s, and was shorter than that of control group [ （ 104.11 ±9.51 ） s, P〈0.001 ） 1- Conclusion ： Abundant information and parameter could be obtained with the MSCT reconstruction images. The images and parameters could make a perfect operative strategy before operation, adjust the direction of pedicle screws during operation, avoid and decrease operative complications effectively.