多层螺旋CT三维重建技术在胸腰椎骨折经椎弓根螺钉内固定术中的应用价值

Use of three-dimensional reconstruction of multi-slice spiral CT in pedicle screw fixation in thoracolumbar spine fracture

目的：探讨多层螺旋CT（MSCT）三维重建技术在胸腰椎骨折患者经椎弓根螺钉内固定术中的应用价值。方法：2007年1月2008年12月,78例胸腰椎骨折患者在我院行椎弓根螺钉内固定术,其中38例使用传统置钉法（Weinstein法或AO法）进行椎弓根螺钉置入（A组）,40例采用MSCT三维重建设计钉道的置钉方法进行螺钉置入（B组）,术后两组均复查胸腰椎正、侧位X线片和CT了解置入螺钉位置情况,应用Lonstein等的方法评判置钉准确率。结果：78例患者共置入椎弓根螺钉436枚,A组38例共置入212枚,12例32枚螺钉穿破椎弓根皮质,其中穿破椎弓根内外皮质21枚,穿破椎弓根上下皮质11枚,置钉准确率84.91%;B组40例共置入224枚,5例6枚螺钉穿破椎弓根皮质,其中穿破椎弓根内外皮质4枚,穿破椎弓根上下皮质2枚,置钉准确率97.33%。两组置钉准确率有统计学差异（P〈0.05）。结论：胸腰椎骨折患者行椎弓根螺钉内固定时应用MSCT三维重建设计钉道的置钉方法较传统置钉方法成功率高。

Objective：To evaluate the use of three-dimensional reconstruction of multi-slice spiral CT（MSCT） in pedicle screw fixation in thoracolumbar spine fracture.Method：A retrospective analysis was carried out in 78 cases of thoracolumbar fracture undergoing pedicle screw fixation from January 2007 to December 2008.Group A included 38 patients undergoing pedicle screw placement by conventional Weinstein or AO method,while group B included 40 patients undergoing pedicle screw placement by use of three-dimensional reconstruction of MSCT.Postoperative anteroposterior and lateral X rays and CT scans were performed in all patients to evaluate the accuracy of the pedicle screw placement.The accuracy of the pedicle screw was compared in two groups by the method of Lonstein.Result：A total of 436 screws in 78 cases were placed.32 perforations of pedicles were found in 12 patients of group A and 6 perforations of pedicles in 5 patients of group B,with the accuracy rate of screw placement in group A and B of 84.91%（212 screws in 38 patients） and 97.33%（224 screws in 40 patients） respectively,which showed significant difference between two groups（P〈0.05）.Conclusion：Compared with conventional methods,screw channel determination by three-dimensional reconstruction of MSCT can improve the accuracy of pedicle screw fixation for thoracolumbar spine fracture.