椎弓根平面CT扫描数字解剖学技术在腰椎术前规划中的应用  

CT scanning applied in the preoperative planning of lumbar spine surgeries

作　　者：王爽[1] 李宏伟[1] 王海洲[1] 于卓力[1] 水岩[1] 王帅[1] 纪楠[1] Wang Shuang Li Hong-wei Wang Hai-zhou Yu Zhuo-li Shui Yan Wang Shuai Ji Nan(Department of Orthopedics, the 202th Hospital of Chinese PLA, Shenyang 110003, Liaoning Province, China)

机构地区：[1]解放军第202医院骨科,辽宁省沈阳市110003

出　　处：《中国组织工程研究》2017年第19期3057-3062,共6页Chinese Journal of Tissue Engineering Research

基　　金：辽宁省自然科学基金计划面上项目(201602746)~~

摘　　要：背景:椎弓根螺钉被广泛应用于脊柱内固定手术,与螺钉误置相关的并发症时有发生,常规影像学检查资料不能提供钉道的准确情况,椎弓根平面CT扫描则有助于直接观察椎弓根螺钉的钉道。目的:利用数字技术探讨椎弓根平面CT扫描在腰椎手术术前规划中应用价值。方法:在136例患者腰椎椎弓根平面CT图像上应用数字技术确定最佳置钉位置,测量可置入的椎弓根螺钉的长度、椎弓根最狭处宽度、椎弓根螺钉与标准矢状面和棘突的夹角,比较各测量值双侧差别,以及椎弓根螺钉与矢状面、棘突夹角的差别。结果与结论:(1)各腰椎的椎弓根螺钉长度双侧差异无显著性意义(P>0.05);(2)L1和L4双侧椎弓根宽度差异有显著性意义(P<0.05);(3)椎弓根与标准矢状面的夹角各腰椎左右两侧差异无显著性意义(P>0.05);(4)椎弓根与棘突的夹角各腰椎左右两侧差异无显著性意义(P>0.05);(5)综上,椎弓根平面CT扫描能准确反映患者椎弓根解剖情况,有助于术前规划,腰椎椎弓根解剖变异较大,置钉时应在良好的术前规划基础上充分考虑个体化因素。BACKGROUND： Pedicle screws are widely used in spinal internal fixation, while complications related to screw mistaken placement can be found occasionally. Conventional imaging examination cannot provide the accurate situation of the nail, and the nail path can be directly revealed on CT.OBJECTIVE： To discuss the application of CT scanning in the preoperative planning of lumbar spine surgery using digital technology.METHODS： 136 patients were enrolled, and digital technology was used to determine the best nailing track on planar CT images. Then the length of the pedicle screws, width of the pedicle, angle between pedicle screws and standard sagittal plane, and angle between pedicle screw and spinous process as well as sagittal plane were measured. The difference in measured values on each side was compared. Also, the difference in angle between pedicle screw and sagittal plane and spinous process was compared.RESULTS AND CONCLUSION： （1） There was no significant difference in the length of pedicle screw in both sides （P 〉 0.05）. （2） There was significant difference in the width of pedicle screw at L1 and L4 of two sides （P 〈 0.05）. （3） The angle between pedicle screw and standard sagittal plane at each level bilaterally did not differ significantly （P 〉 0.05）. （4） The angle between pedicle screw and spinous process at each level bilaterally did not differ significantly （P 〉 0.05）. （5） To conclude, pedicle CT scanning can accurately reflect patients＇ pedicle anatomic situation, which can help surgeons to design an appropriate scheme. Moreover, the anatomical variations of lumbar spine are remarkable, so pedicle screw insertion should be planned individuality.

关 键 词：腰椎 骨钉 解剖学 局部 组织工程 骨科植入物 数字化骨科 椎弓根螺钉 局部解剖学 骨螺丝 辽宁省自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]