影像学测量预测椎弓根螺钉的效力分析

Analysis of the effectiveness of imaging measurement in predicting the effectiveness of pedicle screws

目的评价CT与MRI用于术前预测LDH患者行减压融合手术时椎弓根螺钉长度、直径和角度的准确性。方法选择2018年3月~2020年6月接受微创TLIF治疗的45例L_(2-3)节段腰椎间盘突出症患者,均予以椎间减压融合椎弓根钉棒内固定手术。术前测量MRI(M组)和CT(C组)预测的腰椎椎弓根螺钉长度、直径和角度,术中导航下测量植入螺钉的实际长度、直径和角度(S组)。比较三组间各项参数的差异。结果CT和MRI对腰椎椎弓根螺钉长度、直径和角度的预测值有显著性差异(P<0.01)。CT与实际导航下测得的螺钉角度无显著性差异(P>0.01),CT预测的椎弓根螺钉长度优于MRI(P<0.01)。然而,与CT相比,MRI对螺钉直径的预测更为准确。结论虽然CT扫描提高了椎弓根螺钉长度和放置方向的准确性,但MRI可以预测椎弓根螺钉直径,且CT和MRI同时测量椎弓根平面数据更为准确。

Objective To evaluate the accuracy of CT and MRI in predicting the length,diameter,and angle of pedicle screws in patients with lumbar disc herniation(LDH)undergoing decompression and fusion surgery.Methods A total of 45 patients with L_(2-3) LDH treated with minimally invasive transforaminal lumbar interbody fusion(TLIF)from March 2018 to June 2020 were enrolled in this study.All patients underwent intervertebral decompression and fusion with pedicle screw fixation.Preoperative measurements of the predicted length,diameter,and angle of lumbar pedicle screws were obtained from MRI(Group M)and CT(Group C),while the actual length,diameter,and angle of the implanted screws were measured under intraoperative navigation(Group S).The differences in various parameters among the three groups were compared.Results Significant differences were observed between CT and MRI in predicting the length,diameter,and angle of lumbar pedicle screws(P<0.01).No significant difference was found between CT and intraoperative navigation in the measurement of screw angle(P>0.01).CT provided better prediction of the length of pedicle screws compared to MRI(P<0.01).However,MRI was more accurate in predicting the diameter of the screws compared to CT.Conclusion Although CT scanning improves the accuracy of pedicle screw length and placement direction,MRI can predict the diameter of pedicle screws.The combination of CT and MRI measurements provides more accurate data for the pedicle plane.