以椎弓根螺钉进钉点测量脊椎旋转度:来自实验与临床的双向结果验证  

Measurement of vertebrae rotational degree with the entry point of pedicle screws: Bi-directional verification by experimental and clinical results

作　　者：殷海东[1] 黄明光[1] 赵洪斌[1] 彭焰[2] 杜开利[2] 黄东生[2] 

机构地区：[1]佛山市顺德第一人民医院骨科,广东省佛山市528300 [2]中山大学第二附属医院骨科,广东省广州市510120

出　　处：《中国组织工程研究与临床康复》2010年第4期603-608,共6页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省医学科研基金资助项目(B2009241);课题名:多功能脊椎旋转测量仪的研制及个体化置钉技术研究~~

摘　　要：背景:脊椎的轴向旋转是脊柱侧凸的基本畸形之一,由于受后路矫形术野的限制,如何测量脊柱侧凸后路矫形术中患者的脊椎旋转度一直是困扰脊柱外科的难题。目前对脊柱侧凸患者的脊椎旋转度测量多根据患者矫形术前的X射线片或CT进行,而有关矫形术中测量脊椎旋转度的报道甚少。目的:探讨根据椎弓根螺钉的进钉点测量脊椎旋转度的可行性。方法:在经椎弓根中部的CT横切面上测量两侧椎弓根螺钉进钉点连线之垂直平分线与矢状面的夹角(EPPsag角),将EPPsag角与脊椎标本的实际旋转度、Ho’s法测量结果进行Wilcoxon符号秩检验。利用重复测量单因素方差分析比较EPPsag角观察者内部和观察者之间的差异。利用脊椎旋转测量仪测量9具腰椎标本在不同位置时的脊椎旋转度,并将上述结果与EPPsag角行配对t检验。结果及结论:EPPsag角与脊椎标本的实际旋转度、Ho’s法测量结果差异无显著性意义(P>0.05)。重复测量单因素方差分析显示,EPPsag角的观察者内部和观察者之间差异无显著性意义(P>0.05)。结果提示,根据EPPsag角来表示脊椎旋转度具有准确性高、可重复性好的优点。当脊椎旋转度不超过30°时,脊椎旋转测量仪可准确反映旋转脊椎的EPPsag角。BACKGROUND： Vertebrae axial rotation is a basic deformity of scoliosis, the rotational degree of which is hard to measure due to the field limitation of posterior spinal instrumentation. Currently, vertebrae rotational degree is measured according to preoperative X-ray film or CT, while no reports concerning measuring vertebrae rotational degree during operation. OBJECTIVE： To explore the feasibility of measurement of vertebrae rotational degree with the entry point of pedicle screws. METHODS： Design of the path of pedicle screws on CT scans before surgery, a line bisection and perpendicular to another connecting bilateral entry point of pedicle screws, and the angle of vertebral rotation （EPPsag） was taken as the angle between this line and the saggital plane. The difference among vertebrae rotational degrees measured by conimeter, Ho’s method and EPPsag was compared by Wilcoxon signed rank test. The intra-observer and inter-observer difference was analyzed with One-Way ANOVA. Conimeter was used to measure vertebrae rotational degree of each vertebra in 9 lumbar specimens, and the results was compared to EPPsag. RESULTS AND CONCLUSION： There was no significant difference among EPPsag, actual rotational degree and measuring results of Ho’s method （P 0.05）. The One-Way ANOVA showed that the differences between intra-observer analysis and inter-observer analysis （P 0.05）. The results demonstrated that EPPsag can exhibit vertebrae rotational degree accurately and repeatability. This anger can be obtained accurately with the instrument if the vertebrae rotational degree not exceeding 30°.

关 键 词：脊柱侧凸 椎体旋转 椎弓根 内固定 螺旋CT 

分 类 号：R318[医药卫生—生物医学工程]