俯仰卧位CT三维重建安全实施椎弓根钉双皮质固定的研究  

Safety of pedicle screw bicortical fixation under three-dimensional CT reconstruction in supine and pone position

作　　者：徐超 褚言琛[1] 侯庆先[1] 杨文玖[1] 王志杰[1] Xu Chao;Chu Yanchen;Hou Qingxian;Yang Wenjiu;Wang Zhijie(Department of Spine Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院脊柱外科,266555

出　　处：《中华实验外科杂志》2020年第5期961-964,共4页Chinese Journal of Experimental Surgery

基　　金：山东省重点研发计划项目(2018GSF118080);青岛市科技惠民专项课题(19-6-1-16-nsh)。

摘　　要：目的:通过仰卧位和俯卧位CT三维重建,测量胸腰椎大血管与椎体的最短安全距离,以判断双皮质椎弓根螺钉置入的安全性,降低血管损伤的风险。方法:对20例男性及20例女性(年龄范围为21~76岁,平均年龄53.4岁)的俯卧位、仰卧位胸腰椎(T 9~L 3)三维CT重建进行测量,获取主动脉/下腔静脉与椎体最短距离(D-AV/D-VV)及主动脉/下腔静脉与椎体相对角度(A-AV/A-VV)。以自身对照做配对 t检验。 结果:俯卧位和仰卧位下D-AV在T 12时最短[(3.39±0.99)、(3.18±0.68) mm],差异无统计学意义( t=1.736, P>0.05),在T 9~T 11,L 2阶段其差异有统计学意义[T 9:(5.94±1.73) mm比(5.07±1.25) mm, t=3.956, P<0.05;T 10:(5.93±1.86) mm比(4.65±1.50) mm, t=5.867, P<0.05;T 11:(4.71±2.55) mm比(3.87±1.11) mm, t=3.115, P<0.05;L 2:(4.09±1.58) mm比(4.61±1.98) mm, t=-3.739, P<0.05]。T 9-L 3节段的主动脉从前外侧偏移到前内侧。除T 12、L 1外,其余各椎体俯卧位和仰卧位的A-AV差异均有统计学意义[T 9:(19.47±10.49)°比(32.07±11.33)°, t=-10.619, P<0.05;T 10:(18.47±10.93)°比(22.79±8.48)°, t=-2.219, P<0.05;T 11:(11.85±8.60)°比(16.19±8.40)°, t=-6.245, P<0.05;L 2:(10.70±7.61)°比(13.58±7.38)°, t=-7.806, P<0.05;L 3:(5.30±5.68)°比(8.85±3.80)°, t=-7.489, P<0.05]。俯卧位的主动脉比仰卧位更靠近前内侧。俯卧位和仰卧位D-VV对比差异均无统计学意义[L 1:(10.77±3.93) mm比(11.81±2.29) mm, t=-1.877, P>0.05;L 2:(10.91±3.52) mm比(9.98±2.90) mm, t=1.584, P>0.05;L 3:(5.74±1.95) mm比(5.50±2.17) mm, t=2.320, P>0.05],A-VV对比差异均无统计学意义[L 1:(27.23±4.91)°比(26.26±3.72)°, t=1.480, P>0.05;L 2:(29.07±7.06)°比(27.20±4.93)°, t=1.988, P>0.05;L 3:(24.88±8.21)°比(23.21±4.47)°, t=2.795, P>0.05]。L 3节段D-VV最短[(5.74±1.95)、(5.50±2.17) mm]。下腔静脉无明显移动性,固定在靠近中线20°~30°的范围。 结论:在使用椎弓根螺钉双皮质固定时,确保螺钉突出端小于3 mm是安全的。在判断Objective The distance and position of the great vessels and thoracolumbar spine were measured by three-dimensional CT reconstruction in supine and prone position.These measurements help to determine the safety of pedicle screw bicortical placement and reduce the risk of vascular injury.Methods The experiment involved 20 men and 20 women between ages of 21 and 76 with a mean age of 53.4 years old.The subjects underwent three-dimensional CT reconstruction twice in prone position and supine position.The shortest distance between the aorta/inferior vena CA-AV(IVC)and vertebral body was obtained as D-AV/D-VV respectively.The relative angle of the aorta/IVC and the vertebral body was calculated as A-AV/A-VV.Self-controlled experiments were carried out in the prone and the supine positions.Results The shortest D-AV in prone and supine position was(3.39±0.99)and(3.18±0.68)mm respectively at T12,and the difference was not statistically significant(t=1.736,P>0.05).Tthe D-AV values measured at the T9,T10,T11 and L2 vertebral bodies differed significantly between the prone and the supine positions[T9:(5.94±1.73)mm vs.(5.07±1.25)mm,t=3.956,P<0.05;T10:(5.93±1.86)mm vs.(4.65±1.50)mm,t=5.867,P<0.05;T11:(4.71±2.55)mm vs.(3.87±1.11)mm,t=3.115,P<0.05;L2:(4.09±1.58)mm vs.(4.61±1.98)mm,t=-3.739,P<0.05].The aorta at the T9-L3 segments was shifted from the anterolateral to the anteromedial.The A-AV of the other groups differed significantly between the prone and supine positions in all vertebrae except T12 and L1[T9:(19.47±10.49)°vs.(32.07±11.33)°,t=-10.619,P<0.05;T10:(18.47±10.93)°vs.(22.79±8.48)°,t=-2.219,P<0.05;T11:(11.85±8.60)°vs.(16.19±8.40)°,t=-6.245,P<0.05;L2:(10.70±7.61)°vs.(13.58±7.38)°,t=-7.806,P<0.05;L3:(5.30±5.68)°vs.(8.85±3.80)°,t=-7.489,P<0.05],and the aorta in the prone position was more anteromedial than that of supine position.With regard to D-VV/A-VV,there was no significant difference between the prone and supine positions[L1:(27.23±4.91)°vs.(26.26±3.72)°,t=1.480,P>0.05;L2:(29.07±7

关 键 词：双皮质固定 胸腰段脊柱疾病 椎前血管 俯卧位CT三维重建 

分 类 号：R687.3[医药卫生—骨科学]