下腰椎椎弓根钉进钉点新定位法的影像学与临床研究

Imaging and clinical study of new localization of lower lumber pedicle screw entry points

目的探讨以腰椎椎板嵴延长线与上关节突外侧缘垂线交点定位下腰椎椎弓根钉进钉点的可行性与有效性。方法纳入60例行L3、4、L4、5或L5S1腰椎后路单节段椎弓根钉内固定手术者,术前在腰椎CT冠状面三维图像上找到进钉点,在矢状面及横断面上确定进钉点是否位于椎弓根截面内,作为临床验证基础。采用传统参照横突的定位法置入左侧椎弓根Mark钉(传统组),采用以腰椎椎板嵴延长线与上关节突外缘垂线交点为进钉点置入右侧椎弓根Mark钉(新型组)。结果传统组共置入120枚椎弓根Mark钉,105枚一次成功置入,15枚需调整方向或进钉点,一次置钉准确率87.5%;置钉时间8~20(11.8±3.3)min。新型组共置入120枚Mark钉,114枚一次成功置入,6枚需调整方向或进钉点,一次置钉准确率95.0%;置钉时间5~16(7.9±2.6)min。新型组一次置钉准确率高于传统组,置钉时间短于传统组,差异有统计学意义(P<0.05)。结论影像学及临床结果表明腰椎椎板嵴延长线与上关节突外侧缘垂线交点定位下腰椎椎弓根钉进钉点的方法是安全有效的,一次置入准确率高,置钉时间短,显露范围小。

Objective To explore the feasibility and effectiveness of locating the entry point of lumbar pedicle screw with the intersection of the extension line of lumbar laminae ridge and the vertical line of the lateral edge of the upper articular process.Methods For the 60 patients who underwent L3/4,L4/5 or L5/S1 posterior single-segment pedicle screw fixation,the entry points were found on the three-dimensional coronal CT images of the lumbar spine before surgery,and whether the entry point were located in the pedicle section on the sagittal and transverse was determined as the basis for clinical verification.The pedicle mark was placed with the traditional reference transverse process in the left(traditional group),while the pedicle mark was placed with intersection of the extension line of lumbar laminae ridge and the vertical line of the lateral edge of the upper articular process in the right(new group).Results A total of 120 mark screws were implanted in the traditional group,105 of which were successfully implanted at one time,15 of which needed to adjust the direction or entry point,and the accuracy rate of one placement was 87.5%.The placement time was 8-20(11.8±3.3)min.A total of 120 mark screws were implanted in the new group,114 of which were successfully implanted at one time,6 of which needed to adjust the direction or entry point,and the accuracy rate of one placement was 95.0%.The placement time was 5-16(7.9±2.6)min.The accuracy of placement in the new group was higher than that in the traditional group,and the placement time was shorter than that in the traditional group,with statistically significant difference(P<0.05).Conclusion Imaging and clinical results showed that the method of locating the insertion point of lumbar pedicle with the intersection of the extension line of lumbar laminae ridge and the vertical line of the lateral edge of the upper articular process is safe and effective,with higher accuracy,shorter placement time and smaller exposure.