个体化置钉和导航下颈椎弓根置钉的对比实验研究  

Study on Pedicle Screw Fixation of Cervical Spine Assisted CT-based Navigation System Compared with the Individual Cervical Peddle Screws Placement Technique

作　　者：贺喜顺[1] 杨惠林[1] 朱若夫[1] 谭相齐[1] 王根林[1] 唐天驷[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《苏州大学学报（医学版）》2008年第3期415-417,共3页Suzhou University Journal of Medical Science

摘　　要：目的探索一种能指导颈椎弓根螺钉置钉手术操作的方法。方法随机取经甲醛浸泡过的成人颈椎标本(C1￣C7)共10具(保留完整的脊柱三柱结构及相关的韧带和椎旁肌),对它们进行CT扫描及三维重建,根据CT测量确定进钉点和进钉方向。对其中5具标本的C2￣C7全部进行实体置钉,另外5具标本在CT导航技术的引导下进行置钉。术后进行颈椎椎弓根螺钉水平的CT平扫及矢、冠状面重建,解剖后肉眼大体观察椎弓根螺钉置入的精确性。结果个体化置钉60枚,成功率为90%,优良率为75%;在CT导航引导下置钉60枚,成功率为96.6%,优良率为90%。两种方法比较,成功率差异无统计学意义(P>0.05),但优良率差异有统计学意义(P<0.05)。结论CT导航法置钉较术前三维CT辅助的个体化置钉准确性无明显差异,但优良率高。Objective To explore a safe and effective method for placing the cervical pedicle screws. Methods There were ten adult cadaver specimens of cervica spine （C1-C7） with intact structures including ligament and perivertebral muscles.The spiral computed tomography scan （Elscint CT Twin flash） at the section of 1 mm and three-dimensional reconstruction of all 10 cervical specimens were taken. By CT scan,the parameters of the cervical pedicles were measure.Then taking randomly 5 cervical specimens,according to the CT measurements,an appropriate screw was inserted into pedicle individually. In the other 5 human cadaver cervical vertebraes,Φ3.5 mm screws were inserted into the C2-C7 pedicles by assisted by CT-based navigation system. Cortical integrity of every sample was examined by anatomic dissection, the spiral computed tomography scan and arrows,and coronal reconstruction. Results Sixty screws was inserted into pedicle individually,and the achievement ratio was 90%,the perfectness ratio was 75%,60 screws was placed into pedicle assisted by CT-based navigation system, and the achievement ratio was 96.6%,the perfectness ratio was 90%. By chi-square test for statistical analysis, there were no statistical significance between the accuracy rate of two methods（P〉0.05）. However there was statistical significance between the perfectness ratio between two methods（P〈0.05）. Conclusion Compared with the individual cervical peddle screws placement technique, the perfectness ratio of pedicle screw fixation of cervical spine assisted by CT-based navigation system is higher ,but there are no significant difference in accuracy.

关 键 词：颈椎 椎弓根螺钉 计算机导航 

分 类 号：R683.41[医药卫生—骨科学]