椎弓根CT扫描在腰椎螺钉内固定术中的应用研究

The guiding significance of pedicle plane CT in lumbar pedicle screw fixation

目的探讨腰椎手术前行椎弓根CT扫描在椎弓根螺钉内固定术中的应用价值。方法2014年6月—2015年12月于中国人民解放军第202医院骨科收治拟行腰椎后路钉棒系统内固定术患者88例。研究组45例术前行腰椎椎弓根平面CT图像扫描,图像传输至医学影像存储与通讯系统(PACS)医生诊断工作站,观察椎弓根形态结构,确定最佳置钉点及置钉通道,并测量预置入椎体的椎弓根最狭窄处宽度(PedW)、椎弓根高度(PedH)、预置入的椎弓根骨性通道全长(TL)、水平面椎弓根螺钉置入角度(TSA)等相关参数,进行个体化置钉;对照组43例未行置钉椎体椎弓根CT扫描,对2组患者进行比较。结果2组患者在每钉置钉时间、术中出血量、术中透视次数、重复置钉率等方面比较,差异均有统计学意义(t=6.983、-8.707、-5.364,χ~2=3.987,P<0.05)。结论椎弓根平面CT不仅能帮助术者了解椎弓根的形态结构,更能提供某一特定椎弓根个体化、量化的进钉点及进钉角度、所需螺钉长度等多方面数据,从而能够降低螺钉误置率,减少手术相关并发症。

Objective To evaluate the value of pedicle plane CT in the preoperative planning of pedicle screw fixation for lumbar spine surgery. Methods From June 2014 to December 2015, 88 patients in the department of orthopedics of the202 nd Hospital of PLA were treated by internal fixation with posterior screw rod system. In the study group, the lumbar pedicle plane CT images were scanned in 45 cases, and the images were transmitted to the medical image storage and communication system（PACS） doctor＇s diagnostic workstation. The morphological structure of the pedicle was observed, the best point and channel were determined, and the narrowest and narrower width of the pedicle（PedW） and the height of the pedicle of the vertebral pedicle were measured（PedH）, the pre inserted pedicle bone channel full length（TL）, the horizontal pedicle screw insertion angle（TSA） and other related parameters were measured, for individual screw, the control group 43 cases of non-screw vertebral received pedicle plane CT scanning, the 2 groups were compared. Results The 2 groups of patients were statistically significant（t=6.983, t=-8.707, t =-5.364. χ^2 =3.987. P〈0. 05） in the operation time,intraoperative blood loss, intraoperative fluoroscopy and other aspects. Conclusion Preoperative pedicle plane CT scan can not only help the patients to understand the morphological structure of the pedicle, but also provide a specific individual, quantification of the pedicle screw entry point and angle of screw, screw length and other aspects of the data, which can reduce the screw misplacement rate,reduce surgical complications,which is a simple,reliable and cheap method.