基于CT图像解剖学测量和数字重建透视的经皮骶髂螺钉固定术中透视方法研究  

Intraoperative fluoroscopy in percutaneous sacroiliac screw fixation based on anatomic measurement and digital reconstructed CT data

作　　者：苏永刚[1] 王茂颖[2] 王满宜[1] 

机构地区：[1]北京积水潭医院（北京大学第四临床医学院）创伤骨科,100035 [2]北京积水潭医院（北京大学第四临床医学院）影像医学与核医学科,100035

出　　处：《中华创伤骨科杂志》2012年第5期405-409,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家科技支撑计划课题（2011BAF01B03）

摘　　要：目的基于CT图像对骶髂螺钉置入所涉及的重要解剖边界进行测量和分析，并应用数字重建透视（DRR）技术探讨术中获取理想透视图像的方法。方法收集30例患者的平卧位骨盆CT扫描数据，使用三维重建技术，在图像中确定骶髂螺钉在S1椎体内安全通道的上方、前方和后方骨皮质边界，螺钉在骶孔区的前方、下方骨皮质边界，以及骶骨翼斜坡。测量这些边界与骨盆前后位垂线（基准线）在矢状面的夹角。应用DRR技术，确定透视入口位、出口位和侧位的理想拍摄角度，并观察关键解剖标志的特征性表现，分析术中标准透视图像的采集方法。结果S1椎体的上方、前方、后方骨皮质与基准线在矢状而的夹角平均分别为37．7°±8．6°（23．2°～50．8°）、22．9°±6．7°（13．1°～32．0°）、41．9°±6．8°（33．0°～54．8°），骶孔区的前方、下方骨皮质切线与基准线的夹角平均分别为37．0°±12．0°（19．9°～63．1°）、38．8°±8．0°（25．7°～54．6°），骶骨翼斜坡与基准线的夹角平均为82．4°±13．0°（70．3°～117．3°）。通过基于DRR技术的透视模拟和对相应解剖结构的观察，可以得到拍摄标准入口值、出口位和侧位的透视方法，并能清楚显现各图像上的相应解剖标志。结论本研究所测得的数据个体差异较大，临床上应该根据每例患者的实际情况，并以相关解剖标志的特征性表现为依据，决定术中骨盆入口位和出口位的透视角度。为防止骶髂螺钉穿出斜坡伤及I6神经和髂血管，需要从骨盆侧位透视图像上确认螺钉位置。Objective To explore the intraoperative fluoroscopy in pereutaneous sacroiliac screw fixation based on anatomic measurement and digital reconstructed CT data. Methods The CT data of the pelvis at prostration were collected for 3D reconstruction of the pelvic models from 30 patients with injury to the pelvis or acetabulum. Then the anatomical boundaries of the ＂safe zone＂ of sacroiliac screw insertion were marked on the 3D models, including the upper, front and back cortex boundaries of SI vertebra, the front and bottom cortex boundaries of sacral foramen area, and the sacral alar slope. The angles between these anatomical boundaries and the pelvic baseline were measured on the sagittal plane. The digital reconstructed radiology （DRR） was applied to form the inlet, outlet and lateral images of fluornseopy. The standard protocol to acquire accurate intraoperative images was analyzed by characterization of important anatomic landmarks. Results The angles between the upper, front and back cortex boundaries of SI vertebra and the baseline （α1, α2, α3） were respectively 37.7°±8.6° （from 23.2° to 50.8°）, 22.9° ± 6.7° （from 13. 1° to 32.0°）, 41.9°±6.8° （from 33.0° to 54.8°） . The angles between the front and hottom cortex boundaries of sacral foramen area and the baseline （α4, α5） were 37.0°±12.0° （from 19.9° to 63. 1°） and 38.8° ±8.0° （from 25.7° to 54.6°）. The angle between the alar slope and the baseline （α6） was 82.4°±13.0° （from 70. 3° to 117.3°） . The characteristic manifestations of impnrtant anatomic lanbmarks were observed in the simulated fluoroscopy iraages. Conclusions It is recommended that the projecting angles in the irllet and outlet views should be decided according to the speeifie data of each patient. Because the alar slope can not be clearly identified in the outlet view due to its large inclination, the position of screw insertion should be verified in the lateral view to prevent the screw from penetrating the slope to hu

关 键 词：骨钉 骨盆 体层摄影术 X线计算机 图像处理 计算机辅助 骶髂关节 

分 类 号：R687.3[医药卫生—骨科学]