前后位X线影像在下颈椎前路椎弓根置钉中的指导意义  

Role of A/P radiographs in anterior lower cervical pedicle screw insertion

作　　者：杨小伟[1] 袁峰[2] 王林[1] 欧阳晓[1] 郭开今[2] 陈宏亮[2] 

机构地区：[1]徐州市肿瘤医院骨一科,江苏221002 [2]徐州医学院附属医院脊柱外科

出　　处：《中国骨与关节损伤杂志》2015年第7期683-686,共4页Chinese Journal of Bone and Joint Injury

基　　金：江苏省卫生厅"科教兴卫"开放课题(KF20095)

摘　　要：目的 通过标本置钉探讨术中C型臂X线机前后位透视指导下颈椎前路椎弓根钉（LCATPS）置入技术的可行性及方法。方法 取9具成人尸体颈椎标本（排除畸形、骨折、脱位、肿瘤等病变）,剔除其周围软组织至清楚显露椎体前壁。按照测量结果,直视下置入导针,轴位透视位置满意。随后前后位透视导针在椎弓根中间和入口的位置,最后沿导针置入空心钉,术后行CT扫描评价置钉效果。结果 共置入螺钉90个,术后CT扫描grade 1级72个（80.00%）,grade 2级15个（16.67%）,grade 3级3个（3.33%）,位置可接受的（grade 1~2级）共87个（96.67%）。穿破椎弓根壁者（grade 2~3级）18个全部为外侧壁,左侧12个,右侧6个;其中C33个,C512个,C73个。在椎弓根入口处所有90枚导针全部位于椎弓根入口投影弧边缘;在椎弓根中间有72个（80.00%）位于钩突关节外侧斜坡中间,6个（6.67%）位于钩突关节外侧斜坡内侧,12个（13.33%）位于钩突关节外侧斜坡外侧（灵敏性0.828,特异性1.00）,且与grade分级具有相关性（Spearman相关系数0.515,P〈0.001）。结论 前后位X线影像上导针在椎弓根入口应位于椎弓根投影弧边缘,在椎弓根中间应位于钩突外侧斜坡投影中间,初步认为前后位X线影像可以指导LCATPS的置入。Objective To investigate the feasibility and methods of lower cervical anterior transpedicular screw （LCATPS） insertion by assessing MP radiograph. Methods Normal cervical spine specimens of 9 cadavers were carefully dissected to resect the surrounding tissue and to clearly expose the eentrum antetheca. According to the measurement results, the guide wire was inserted under C-arm fluoroscope and the position was satisfactory by pedicle axial view. Then the guide wire was pulled back. A/P radiograph in the middle of the pedicle and the entrance of the pedicle was taken by C-arm fluoroscope. At last cannulated screws were inserted and the efficacy was evaluated by postoperative CT scanning. Results Ninety screws were inserted. The pedicle perforation was classified by CT, grade 1：72 （80.00%） screws, grade 2：15 （16.67%） screws, grade 3： 3（3.33%） screws. Eighteen perforated pedicles were all in the lateral wall, 12 in left, 6 in right, C3 3 screws,C5 12 screws, C7 3 screws. At the entrance of the pedicle, all screws were in the entrance arc of the pedicle on A/P radiograph. At the middle of the pedicle, 72 （80.00%） screws were within the lateral slope of uncinate process （LSUP）（grade 1,2）, 6 （6.67%） were medial to the I_SUP on MP radiograph, 12 （13.33%） screws were lateral to the I.SUP on MP radiograph, and it was significantly correlated with grade grading （Spearman correlation coefficient 0.515, P 〈0.001）. Conclusion The tip of guide wire should be in the entrance arc of the pedicle, and at pedicle entrance, should be medial to the I_SUP on A/P radiograph at the middle of the pedicle. It is preliminarily concluded that A/P radiographs can guide the implantation of the LCATPS.

关 键 词：颈椎 前路 椎弓根 内固定 X线 

分 类 号：R445[医药卫生—影像医学与核医学]