CT多平面重建预评估腰椎经皮椎弓根螺钉置入损伤关节突关节的风险  

CT multiple-level reconstruction for preoperational estimation of facet joint violation in lumbar percutaneous pedicle screw placement

作　　者：张晓芸 毕树雄 郝帅 Zhang Xiaoyun;Bi Shuxiong;Hao Shuai(Shanxi Medical University,Taiyuan 030000,Shanxi Province,China;Shanxi Bethune Hospital,Taiyuan 030000,Shanxi Province,China)

机构地区：[1]山西医科大学,山西省太原市030000 [2]山西白求恩医院,山西省太原市030000

出　　处：《中国组织工程研究》2020年第21期3347-3352,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮椎弓根螺钉内固定技术被广泛应用于治疗腰椎疾病。经皮椎弓根螺钉由于是在术中C形臂X射线引导下操作,对螺钉与关节突关节之间的位置关系难以完全控制,可能导致关节突关节损伤。既往有学者认为体质量指数>29.9 kg/m2、小关节角>35°及年龄<65岁是经皮椎弓根螺钉损伤关节突关节的高危因素。由于不同腰椎椎弓根轴线与关节突关节的位置关系不同,螺钉对关节突关节的破坏是否存在差异目前尚无相关报道。目的:探讨腰椎CT多平面重建技术在腰椎经皮椎弓根钉置入术前预估螺钉损伤腰椎关节突关节中的价值。方法:选择100例行经皮椎弓根钉置入内固定治疗腰椎骨折及腰椎退行性疾病的患者,对治疗方案均知情同意,且得到医院伦理委员会批准。于术前CT斜轴位、斜矢状位及斜冠状位调整多平面重建的定位线,重建出椎弓根的切面断层,以斜冠状位线为中心设置直径为6.5 mm的标定圆模拟经皮椎弓根钉轴向截面,观察标定圆侵犯关节突关节程度,设为术前组;术后行腰椎CT检查观察螺钉损伤关节突关节程度,设为术后组。评价2组间不同节段关节突关节损伤螺钉数及组内不同节段关节突关节破坏比率的差异。结果与结论:①共计置钉478枚,术前组显示标定圆侵犯关节突关节109枚,占比22.8%,其中L1-L5标定圆侵犯关节突关节螺钉数及占比分别为6枚(6.8%)、9枚(10.5%)、19枚(18.3%)、30枚(30.0%)和45枚(45.0%);②术后组显示关节突关节损伤115枚,占比24.1%,其中L1-L5螺钉损伤关节突关节螺钉数及占比分别为10枚(11.4%)、7枚(8.1%)、15枚(14.4%)、26枚(26.0%)和41枚(41.0%);③McNemar配对χ2检验不同腰椎节段P值分别为:L1 P=0.08,L2 P=0.22,L3 P=0.20,L4 P=0.05,L5 P=0.08,2组结果比较差异均无显著性意义;④Kappa检验2组一致性分别为:L1 Kappa值=0.67,L2 Kappa值=0.80,L3 Kappa值=0.80,L4 Kappa值=0.87,L5 Kappa值=0.92;术前组BACKGROUND:Percutanoues pedicle screw internal fixation is widely used for treating lumbar disease.Because the surgery is guided by the C-arm,it is hard to control the position between screws and facet joint to cause the facet joint violation completely.Body mass index>29.9 kg/m2,facet joint angle>35°and age<65 years old are considered as the high risk factors for percutaneous pedicle screw injury of articular processes.Due to the different positional relationship between the pedicle axis of the lumbar spine and the articular process joint,there is no related report on whether the destruction of the articular process joint by screws is different.OBJECTIVE:To investigate the significance of lumbar CT multi-planar reconstruction for preestimating facet joint violation in lumbar percutaneous pedicle screw placement.METHODS:One hundred patients with lumbar fracture and degenerative disease who underwent percutaneous pedicle screw placement were selected.All patients signed the informed consents and the study was approved by the ethics committee of the hospital.The position line of the oblique axial view,oblique sagittal view and oblique coronal view was adjusted to reconstruct the section of pedicle.A circle with the 6.5 mm of position line of the oblique coronal view as its center to check the relationship between the circle and facet joint served as preoperation group.CT examination was performed after surgery for evaluating the degree of facet joint violation by screws and served as postoperation group.The amount of screws which damage the facet joint of different vertebrae between two groups and the damage rate among vertebrae in each group were compared.RESULTS AND CONCLUSION:(1)Totally 478 screws were placed,109(22.8%)screws violated facet joints in the preoperation group,and the amount of circles which violated facet joint was 6(6.8%),9(10.5%),19(18.3%),30(30.0%),and 45(45.0%)from L1-L 5.(2)115(24.1%)screws violated facet joints in the postoperation group,the amount of circles which violated facet joint was 1

关 键 词：腰椎 经皮椎弓根置钉 CT 多平面重组 椎关节突关节 骨螺丝 并发症 微创脊柱外科 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]