中下颈椎椎弓根个体化置钉的MSCT辅助测量价值  

Application of Middle-Lower Cervical Pedicle Measurement by MSCT in Performing Individualized Cervical Transpedicular Screw Placement

作　　者：李国良[1] 曹阳 胡晓云[1] 刘仪[3] 钱萍艳[1] 高韵[1] 胡钢锋[1] 高爱国[3] 方向明[1] 

机构地区：[1]南京医科大学附属无锡人民医院影像科,214023 [2]江苏省无锡市惠山区人民医院影像科,214187 [3]南京医科大学附属无锡人民医院骨科,214023

出　　处：《临床放射学杂志》2014年第8期1273-1276,共4页Journal of Clinical Radiology

基　　金：南京医科大学科技发展基金重点项目(编号:2010NJMUZ60);国家自然科学基金青年项目(编号:81101043)

摘　　要：目的 探讨MSCT在模拟颈椎弓根个体化置钉术中的参数精确测量的可行性和应用价值。方法 选取成人颈部动脉增强CT血管成像（CTA）及颈部CT平扫患者共80例,经0.75 mm层厚/间隔、骨算法重建以获得清晰的骨结构影像。利用后处理工作站,设螺钉直径4.0 mm,利用MPR及InSpase软件模拟个体化置钉手术,分别用单线法及双线法（模拟置钉,直径4.0 mm）观察、测量160对C3-7椎弓根中轴线与矢状面的水平夹角（PTA）及与对应椎体水平面的矢状夹角（PSA）,其中设定头侧PSA为正值、足侧PSA为负值。对同椎体水平的测量数据进行平均值计算及配对t检验,对不同椎体水平间的数据进行Kendall检验。结果 （1）共发现椎体先天融合（阻滞椎）2例累及4个椎体,先天性椎弓根一侧骨皮质缺损1例。（2）单线法与双线法测量C3-7的PTA、PSA的平均误差范围差异有统计学意义（P〈0.01）,后者更能模拟个体化置钉的实际要求。（3）以双线法测量,PTA平均值分别为42.9°、45.5°、42.4°、37.1°、29.0°;PSA平均值分别为8.4°、5.0°、-4.0°、-7.8°、-8.1°。结论 （1）MSCT的重建技术能够确定颈椎椎弓根个体化置钉术进钉方向和所需参数,并能精确测量PTA和PSA等关键参数。（2）PTA和PSA的精确测量为颈椎椎弓根个体化置钉提供理论指导,尤其是PSA的在体测量能够为骨科医师＂进钉手感＂的培养提供可靠依据。Objective To explore the feasibility and application of the precise measurement of middle-lower cervical pedicle parameters by multi-slice CT （MSCT） scanning for the performance of individualized cervical transpedicular screw placement Methods A total of 80 adult patients were enrolled in this study. Cervical enhanced CT angiography and plain CT scanning were performed in all patients. The clear and detailed bone structures were obtained by using bone algorithm reconstruction technique with slice-thickness and slice-interval of 0.75mm. With the help of post-processing workstation using the software of MPR and InSpase, the simulated operation of individualized screw placement was performed with 4.0 mm diameter screws. The pedicle transverse angle （PTA） and sagittal angle （PSA） were measured using the methods of single line and double line （ analog nailing, 4.0 mm in diameter） in 160 pairs of C3 _7 pedicles, setting positive value for PSA of the cranial direction, negative value for foot side PSA. The data were checked with Kendall method. Results （ 1 ） Fusion vertebrae （ n = 2） and congenital cortical defect （ n = 1 ） were found. （2） The results had significant difference （ P 〈 0.05 ）. Using single line and double line method the cervical 3 - 7 average maximum safe range of PTA and PSA were measured. The double line method was superior to single line method in simulating the actual situation of individualized nailing. （3） With double line method the mean values of PTA and PSA were 42.9°, 45.5°, 42.4°, 37.1°, 29.0° and 8. 4°, 5.0°, - 4.0°, - 7.8°, - 8.1 °respectively. Conclusion （ 1 ） Reconstruction techniques of MSCT can be used to determine the direction and the required parameters for individualized screw placement. The PTA and PSA can be accurately measured with this technique. （2） The accurate measurement of PTA and PSA, particularly PSA, in vivo provides the orthopedic surgeon with theoretical guidance and reliable basis in the performance of screw p

关 键 词：颈椎 椎弓根 螺钉 体层摄影术 X线计算机 个体化测量 

分 类 号：R687.3[医药卫生—骨科学]