三维CT在儿童脊柱侧弯畸形手术矫正中的应用

Three-dimensional CT in surgery for children with spinal deformity

目的探讨三维CT在儿童脊柱侧弯畸形手术矫正过程中的应用价值。方法 55例儿童脊柱侧弯(其中特发性脊柱侧弯42例,先天性脊柱畸形13例),术前采用俯卧位三维CT扫描,对椎弓根钉进针点进行三维定位,同时测量相应脊椎椎弓根松质骨宽度、进针长度,以及椎体内倾角、旋转角、矢状角,对手术置钉进行精确评估。术后三维CT扫描评估置钉准确率并测量脊柱冠状位主弯Cobb′s角平均矫正度数。结果 55例儿童脊柱侧弯患儿共置入螺钉450枚,置钉准确率为98.22%;术前冠状位CT测量主弯Cobb′s角平均为62.3°(43.0°～108.6°),术后冠状位CT测量脊柱侧弯主弯Cobb′s角平均为16.5°(2.0°～60.7°)。结论应用三维CT扫描定位进针点,可指导术中准确安置椎弓根钉,有利于提高手术操作安全,减少人为的误差,防止和减少并发症的发生。

Objective To evaluate the use of three-dimensional CT scan in surgery for children with spinal deformity. Methods 55 cases with scoliosis were studied,including 42 cases with idiopathic scoliosis and 13 cases with congenital scoliosis. All the cases underwent three-dimensional CT scan in prone position before operation,which located the pedicle entry point, worked out pedicle depth and the width of the pedicle spongy bone,meanwhile measured the pedicle inclination angle, vertebral rotation angle and the sagittal angle. Accuracy of pedicle screw placement and the mean Cobbrs angle in coronal plane were measured through three dimen- sional CT scan after operation. All the data was processed though statistical analysis. Results There were 450 pedicle screws in- serted in total, with the accuracy rate of 98.22 °. The mean preoperative Cobbts angle and the postoperative angle scanned by three dimensional CT in coronal plane were 62.3°（43.0°-108.6°） and 16.5°（2.0°-60.7°） respectively. Conclusion Three dimensional CT scan preoperatively provides more complete measuring parameters,and helps to localize the insertion point more precisely, which can be used widely in clinical practice.