椎弓根三维形态的CT测量在实施个体化置钉中的作用研究

Study on the Effect of Personalized Pedicle Screw Fixation Based on Three-Dimensional Measurement of Vertebral Arch

目的观察胸腰段椎弓根CT测量在椎弓根螺钉内固定中的作用,寻找一种个体化椎弓根螺钉置入的方法。方法选择T12和/或L1段骨折患者68例,术前行CT检查及椎体图像的三维重建,通过旋转和切割测量T11～L2的椎弓根形态,根据CT测量椎弓根的实际投照点进行调整,对患者进行胸腰段椎弓根螺钉的植入,术后对植入的椎弓根螺钉行CT扫描。结果所置入的352个椎弓根行植钉术,320个完全在椎弓根内,仅有32个螺钉穿透椎弓根皮质,无一例椎弓根螺钉进入椎管内。术后平均随访18.6个月,均无临床并发症的发生,Frankel平均增加1.8级。术后有5例患者出现断钉(6枚),1例患者出现断棒。结论利用三维CT测量的数据辅助,严格按照个体化的椎弓根的轴线方向植钉,在置钉时可以提高植钉的成功率。

Objective To observe the role of spinal CT measurement in transpedicular screw fixation of thoracolumbar vertebral arch, and seek a personalized method of transpedicular screw fixation. Methods Three-dimensional （3D） CT measurement and image reconstruction were made on 68 patients of vertebral fracture in LI and/or %2, 3D image was processed with rotation and cutting to stimulate the topography of vertebral arch in T11 - L2. The experiment was based on the factual projection of vertehral arch, which was the intersection point of axis line on cross section and sagittal section. Suitable screws were chosen to insert according to the liner parameters of pedicle. Results Totally 352 pedicles of vertebral arch were inserted with screws, 320 cases were entirely located within the pedicle, while only 32 screws penetrated cortex. All postoperative patients were followed up for an averageof 18.6 months. No clinical complications were found, and Frankel rank increased 1.8 degree. Five cases appeared with broken screw （6 screws） and one case presented with broken pole. Conclusions The insertion of pedicle screw is safe on the base of 3D CT measurement, while transpedicular screw fixation must be strictly operated according to the axis of the pedicle to improve the accuracy rate of transpedicular screw fixation.