特发性脊柱侧凸患者胸椎椎弓根的CT测量及其临床意义

CT measurement of thoracic vetebral pedicle in idiopathic scoliosis and its clinical relevance

目的:测量特发性脊柱侧凸患者胸椎椎弓根的有关数据,探讨其临床应用价值。方法:在30例特发性脊柱侧凸患者术前CT扫描片上测量胸椎椎弓根的宽度、深度、角度、椎体旋转角度等数据,根据所得数据选定置入螺钉的直径、长度,确定置入方向和深度。术后对置入螺钉的胸椎椎弓根节段行CT扫描,判断置钉位置。结果:CT测量的各项数据显示胸椎椎弓根适合椎弓根螺钉的置入。以此为依据术中置入胸椎弓根螺钉共245枚,228枚(93%)置入无误,6枚穿破椎弓根外壁,9枚穿破椎弓根下壁,2枚穿破椎弓根内壁,无神经系统并发症。结论:术前CT扫描测量特发性脊柱侧凸患者的胸椎椎弓根的有关数据可为选择适当长度和直径的螺钉并将其准确置入胸椎椎弓根内提供参考,从而保证螺钉安全置入。

Objective:To evaluate the clinical relevance of CT measurement of the thoracic pedicle in the treatment of idiopathic scoliosis.Method:There were30cases of consecutive patients with idiopathic scoliosis in this study.All patients underwent CT measurements of thoracic pedicle preoperatively and the width,depth and angle of the pedicle,degree of the rotation of the vertebral body were measured.The size of the pedicle screw and the angle of the screw insertion were selected according to the data from CT measurements.The accuracy of thoracic pedicle screw insertion was evaluated through postoperative CT scan at the instrumented levels.Result:All data from CT measurement met the requirement for thoracic pedicle insertion.There were245screws inserted in the thoracic pedicle with highest level in T2and lowest in T12.Postoperative CT scan was carried out at all the level which inserted with pedicle screw for all the patients.The results showed that228(93%)screw inserted accurately and6screws penetrated improperly,9screws inferiorly and2screws medial-ly.There was no neurological complication occurred in all the patients.Conclusion:Preoperative CT measurement of the thoracic pedicle in the treatment of idiopathic scoliosis can provide important data of pedicle width,depth and angle.Therefore the thoracic pedicle screw can be inserted safely and satisfactory result can be achieved.