脊柱椎弓根螺钉置入术后螺钉位置MSCT评估  

Evaluation of screw position by multi-slice CT after pedicle screw placement

作　　者：刘庆余[1] 陈健宇[1] 梁碧玲[1] 李洁婷[1] 曾伟科[1] 

机构地区：[1]中山大学附属第二医院放射科,广东广州510120

出　　处：《中国医学影像技术》2007年第8期1214-1217,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨MSCT在椎弓根螺钉置入术后应用中的价值。方法对23例患者共112枚椎弓根螺钉进行了MSCT检查,其中颈椎螺钉4枚,胸椎螺钉39枚,腰骶椎螺钉69枚。详细记录螺钉与椎弓根、椎体之间的相对位置。结果75枚（67.0%）螺钉完全位于椎弓根内,37枚（33.0%）螺钉穿透椎弓根骨壁,其中14枚（12.5%）螺钉穿透距离〈2.0mm,10枚螺钉（8.9%）穿透距离在2.0-4.0mm之间,13枚螺钉（11.6%）穿透距离〉4.0mm。螺钉穿透椎弓根的方向以外侧壁居多,占43.2%（16/37）。胸椎椎弓根穿透率明显高于腰骶椎（P〈0.05）,分别为43.6%（17/39）和23.2%（16/69）。14枚螺钉在椎体内的长度小于椎体矢状径的50%,12枚（10.7%）螺钉穿透椎体前缘,穿出椎体距离为1.0-8.0mm,平均4.3mm。由于螺钉位置不当而引起神经根损伤以及颈椎横突孔穿透各1例。结论MSCT是评价椎弓根螺钉位置的一种有效的检查方法,对椎弓根螺钉置入术后患者进行MSCT检查具有重要的临床意义。　Objective To evaluate the clinical value of multi-slice spiral CT （MSCT） in patients after pedicle screw placement. Methods One hundred and twelve pedicle screws were placed in 23 patients, including 4 screws in cervical spine, 39 in thoracic spine, and 69 in lumbar-sacral spine. All 23 patients were performed with MSCT scan. The relative position of the screw to the pedicle and vertebra was investigated. Results Seventy-five pedicle screws （67.0%） were completely contained within the pedicle, and 37 pedicle breaches （33.0%） occurred. Pedicle breach distance was 〈2.0 mm in 14 screws （12.5%）, ranged 2.0-4.0 mm in 10 screws （8.9%）, and 〉4.0 mm in 13 screws （11.6%）. The majority of breaches were lateral wall disruption （43.2%, 16/37）. Pedicle breach was significantly higher in the thoracic （43.6%） compared with the lumbar-sacral spine （23.2%） （P〈0.05）. The length of screw within vertebra was less than 50% of the vertebra sagittal length in 14 screws, and a total of 12 anterior cortical breaches （10.7%） occurred, with anterior breach distance 1.0-8.0 mm, mean 4.3 mm. One patient with neurologic injury and one patient with transverse foramen compromise were reported to associate with screw misplacement. Conclusion MSCT appears to be an effective modality to assess the pedicle screw position, and it is of important value for patients after screw placement to perform MSCT scans.

关 键 词：椎弓根螺钉 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R826.64[医药卫生—放射医学]