术前X线及CT测量在个体化置钉治疗胸腰椎骨折中的应用研究

Application of preoperative measurement of X-ray and spiral CT image to the treament of thoracolumbar fracture by posterior pedicle screw fixation

目的 提高后路经椎弓根内固定术治疗胸腰椎骨折的安全性和有效性。方法 术前经 X线及 CT测量椎弓根横径、间距、椎体前、后高、患椎后凸角度、矢状面及水平面椎弓根螺钉置入角、钉道深度、残余椎管面积及椎管面积理论值 ,用 SAS软件进行统计学处理。结果 T1 0 ～ L5之间椎弓根横径、间距、钉道深度、TSA节段性差异较大。SSA离散程度最大。手术置钉位置良好 ,角度及深度适中。术前、术后椎体高度压缩度、后凸角、椎管面积改善 ,随访结果满意。结论 术前 X线、CT测量有助于判断胸腰椎骨折的类型和损伤程度 ,可为术前选择螺钉直径提供依据 ,有助于个体化置钉 。

Objective To evaluate the security and the efficiency of posterior pedicle screw fixation.Methods 60 cases with thoracolumbar fracture were measured by X ray and spiral CT images.Results The measurements of the pedicle width,the screw path length,the transverse screw angle and the distances between pedicles from T 10 to L 5 showed great significant difference on different vertebral level.The sagittal screw angle is relative unsteady in posterior internal fixation.The position of screw was good,the angle was correct,and the length was suitable.The measurements of the compress of the vertebrace,the spinal Cobb angle and the area of the vertebral canal before and after operation showed significant difference.The cases had been followed up for 12 to 36 months and the result was satisfactory.Conclusion The measurement by X ray and CT before operation is helpful to judge the type of thoracolumbar and the degree of spinal cord injury. The measurement of the pedicle width may be used to decide the diameter of the screw.The identification of entering pedical screw is helpful to evaluate the security and the efficiency of posterior pedicle screw fixation.