脊柱骨折椎弓根螺钉置入准确率的影像学评估

Radiological assessment of the accuracy of screw placement for spinal fractures

背景:在脊柱骨折椎弓根螺钉置入中采用X射线及CT均能提高置钉准确率,且X射线成本较低,可重复好,能减少射线损伤,但是该结论尚未得到证实。目的:探讨X射线在脊柱骨折椎弓根螺钉置入中的应用效果及影像学评估方法。方法:选择2014年11月至2016年12月医院收治脊柱骨折患者20例(骨折部位T1-8),根据患者情况进行手术治疗,分别在椎弓根中部、椎体后缘及椎体前缘皮质下沿着椎弓根轴线进针,利用C臂X射线记录其位置及对应关系变化规律,患者在X射线引导下置入100枚椎弓根螺钉,置入螺钉后利用CT完成椎弓根螺钉位置、深度的评估,分析X射线在脊柱骨折椎弓根螺钉置入中的应用效果。结果与结论:C臂X射线下置入的实际钉道T1,T2,T3,T4,T5,T6,T7,T8钉道长度与虚拟钉道长度比较差异无显著性意义(P>0.05),X射线置钉时同样能提高置钉的准确性。共置入100枚螺钉,94枚螺钉优,螺钉完全置入椎体内,方向、深度等符合要求;6枚螺钉良,螺钉基本在椎弓根内,螺钉的深度、方向基本符合要求,部分螺钉轻微穿破,但骨皮质较少;0枚差;100枚脊柱骨折椎弓根螺钉中标本并未出现穿破,穿破率为0%。结果证实,利用C臂X射线透析分步引导脊柱骨折椎弓根螺钉置入效果理想。

BACKGROUND： Volar locking plate is the domin Pedicle screw placement for spinal fractures with X-ray and CT assistant can optimize the accuracy of screw placement. Additionally, X-ray is cheap, repetitive and can reduce radiation injury, but has not been confirmed. OBJECTIVE： To evaluate the effect and imaging evaluation of X-ray in pedicle screw placement for spinal fractures. METHODS： Twenty patients with spinal fractures at T1-8 levels in our hospital from November 2014 to December 2016 were enrolled. The needles were placed along the pedicle axis at the middle of the pedicle,vertebral posterior and vertebral anterior, and its position was recorded by C-arm X-ray, 100 pedicle screws were placed under C-arm X-ray, and then evaluated by CT to analyze the application effect of X-ray. RESULTS AND CONCLUSION： The screw length between the actual placement at T1, T2, T3, T4, Ts, T6, T7, T8 screw length under C-arm X-ray and virtual ones had no significant differences （P 〉 0.05）, suggesting that X-ray can optimize the accuracy of screw placement. A total of 100 screws were placed, 94 screws were excellent, which were placed into the vertebral body completely, and the direction and depth were in accordance with the requirements. Six screws were good, some screws slightly worn out, but the cortical bone was less, and none was poor. No accident of pedicle violations was found. To conclude, C-arm X-ray-assisted screw placement for spinal fractures exhibits ideal outcomes.