多层螺旋CT三维重建技术辅助下颈椎椎弓根植钉的实验研究  

EXPERIMENTAL STUDY ON SCREW INSERTION IN LOWER CERVICAL PEDICLE ASSISTED BY MULTI-SPIRAL COMPUTERIZED TOMOGRAPHY THREE DIMENTIONAL RECONSTRUCTION TECHNIQUES

作　　者：曹珺[1] 何飞[1] 何利平[2] 李超[1] 代耀军[1] 张春强[1] 黄河[1] 

机构地区：[1]昆明医学院第一附属医院骨科昆明,650032 [2]昆明医学院公共卫生学院

出　　处：《中国修复重建外科杂志》2010年第5期525-530,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省自然科学基金面上项目(2007C242M);云南省科技计划联合专项(2008C0013R);昆明市社会发展科技计划重点项目(08S100311)~~

摘　　要：目的评估多层螺旋CT(multi-spiralCT,MSCT)三维重建技术辅助下颈椎椎弓根螺钉植入的临床应用价值。方法取8具防腐处理颈椎标本,MSCT扫描后采集信息传送至工作站,根据下颈椎椎弓根植钉需求,进行容积成像(volume rendering,VR)以判断病情,多平面重组(multi-plannar reformation,MPR)行个体化分析,设计各个椎弓根螺钉的理想通道,测量相关参数。然后参照测量数据,分别在8具标本植入椎弓根螺钉。植钉完成后,再次对标本扫描,通过MPR对所植螺钉进行准确性评估。2007年5月-2009年11月,对28例行下颈椎椎弓根螺钉固定术患者,常规颈椎MSCT检查并行VR/MPR重建,评估病情,确定最短固定节段,采集目标椎弓根植钉数据。结果单枚螺钉植入时间为(392±62)s。植钉前测量除1个椎弓根闭锁(1.25%,1/80)、5个椎弓根冠状位直径<3mm(6.25%,5/80)不适于植钉外,共植钉74枚。一次植钉成功率为95.95%(71/74)。其中68枚(91.89%)螺钉完全位于椎弓根内;6枚(8.11%)发生穿破,按Richter分级标准:1级5枚(6.76%),2级1枚(1.35%);该椎弓根螺钉穿破率与文献报道解剖标志定位法穿破率(47.37%)以及椎板开窗探查法穿破率(25.00%)比较,差异有统计学意义(P<0.05);与Abumi法(6.70%)、漏斗技术(7.10%)、管道疏通法(5.20%)及计算机导航技术(11.30%)比较,差异无统计学意义(P>0.05)。临床应用28例,术前测量发现1个目标椎弓根部分缺失、1个裂纹骨折,调整手术方案,术中共植钉121枚。术后17例(76枚)MSCT复查见67枚(88.16%)完全位于椎弓根内;9枚(11.84%)发生穿破,其中1级6枚(7.89%),2级3枚(3.95%)。结论MSCT三维重建技术可对下颈椎椎弓根固定理想钉道进行术前个体化准确测评,术中严格按照个体化参数植钉,可提高植钉的精确度和安全性;利用MPR图像对螺钉植入的准确性进行评价是可行的。Objective To assess the clinical significance of transpedicular screw insertion in lower cervical vertebra assisted by multi-spiral CT （MSCT） three dimentional （3D） image reconstruction techniques. Methods Eight cervical vertebra specimens were examined by MSCT,and the messages were sent to SGI02 Workstation; according to the parameter requirements of lower cervical pedicle fixation,by using post-process of volume rendering （VR） the condition was judged and multi-plannar reformation （MPR） was used to do individual analysis; and the ideal path of screw insertion was obtained and the related parameters were measured. After preoperative plan being finished,referring to these measured parameters,3.5 mm screws were inserted into C3-7 pedicles of these 8 specimens. After insertion of screws,MSCT scanning and 3D reconstruction were performed again to evaluate the accuracy of lower cervical pedicle screw inserting. From May 2007 to November 2009,28 patients who received screw insertion in lower cervical spines were given MSCT scanning and 3D reconstruction to evaluate the illness situation,to confirm shortest fixation volumes,and to collect the parameters of aim pedicle screw insertion. Results The time of insertion for each screw was （392 ± 62） seconds. It was found that one pedicle was clausura （1.25%,1/80） and five pedicle diameters in coronal view were less than 3 mm （6.25%,5/80）,which all were not fit for screw insertion. A total of 74 screws were placed successfully. One-time success rate of screw insertion was 95.95% （71/74）. The total accuracy rate was 91.89% （68/74）. Six screws penetrated （8.11%）. According to the Richter penetrating classification：grade one was 6.76% （5/74） and grade two was 1.35% （1/74）. There were significant differences （P〈 0.05） in penetrated rate between our study and anatomic landmark localization （47.37%）,Miller methods （25.00%）,and there was no significant difference （P 〉0.05） when compared with Abumi method （6.70%

关 键 词：下颈椎 椎弓根内固定 多层螺旋CT 三维重建 个体化术前设计 

分 类 号：R687.3[医药卫生—骨科学]