C型臂X线透视判断上中胸椎椎弓根螺钉位置的可靠性研究  

The reliability of C-arm fluoroscopy in judging the accuracy of pedicle screws' position applied in the upper-middle thoracic region

作　　者：徐卫星[1] 陈其昕[2] 李方才[2] 

机构地区：[1]浙江省立同德医院骨科,杭州市310012 [2]浙江大学医学院附属二院骨科,杭州市310009

出　　处：《中国脊柱脊髓杂志》2008年第2期142-145,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨C型臂X线透视判断上中胸椎椎弓根螺钉置入位置的准确性。方法:选用10具成年防腐保存的脊柱标本(T1～T6),根据椎弓根水平面倾斜角用手锥建立螺钉位置偏内(38个)、偏外(36个)、居中(46个)3种模型,分别置入导针和椎弓根螺钉后依次透视正位、侧位、椎弓根轴位、导针轴位、椎弓根螺钉轴位,根据导针和椎弓根钉与椎弓根投影的相互位置关系判断导针和椎弓根钉位置,同时行CT扫描观察椎弓根螺钉位置以及椎弓根内外侧皮质穿透情况,根据CT扫描结果判断C型臂X线图像对椎弓根螺钉置入监测的准确率。结果:120个椎弓根正位透视10枚偏内,其中5枚实际位置良好,未发现偏外者,正确率为35%;侧位透视不能判断偏内及偏外错误;椎弓根轴位透视将5枚居中判为偏内,准确率为95.9%;导针和椎弓根钉轴位透视均将4枚偏外模型判为居中,准确率为96.7%。结论:C型臂X线透视时椎弓根轴位和导针轴位图像能较准确判断椎弓根钉导针位置。Objective：To explore the reliability of C-arm fluoroscopy in judging the accuracy of pedicle screws＇ position applied in the upper-middle thoracic region.Method：10 adult cadaveric thoracic samples（T1- T6） were selected.According to the incline angle of thoracic pedicle in the axial plane,3 kind models were established. After the surgical probe and pedicle screw were placed respectively,the fluoroscopic imaging of A-P view,lateral view,axis view of pedicle,axis view of probe and axis view of pedicle screw were observed individually.According to the projection of the probe and the pedicle screw,the relative position of the probe and the pedicle screw were determined.After that,CT scan was performed to confirm the position of screws and evaluate the penetration of the inside and outside cortexes of the pedicles.By compared with the result of CT scaning,the accuracy of the resuh of the C- arm fluoroscopy was determined.Result：Out of the 10 screws which judged inwardly under the AP view,5 screws were actually in right position,no screw was found out-wardly.The accuracy rate reached 35%.The inward or outward deviation of the screws could not be determined by the lateral view.5 screws in right position were judged to be inward deviation by the axis view of pedicle, the accuracy rate was 95.9%.4 outward deviation screws were judged to be central position by the axis view of probe and axis view of pedicle screw,the accuracy rate was 96.7%.Conclusion：By means of C-arm fluoroscopy,the axis view of probe and the axis view of pedicle screw can accurately reflect the position of the pedicle screw.

关 键 词：胸椎 C型臂X线机 椎弓根 螺钉 

分 类 号：R814.4[医药卫生—影像医学与核医学] R687.3[医药卫生—放射医学]