术前CT测量联合术中横突中点定位法行椎弓根螺钉置入的准确性及可行性分析  

Analysis on the accuracy and feasibility of CT measurement pre-operation combined with pedicle screw placement with intraoperative transverse midpoint positioning

作　　者：王晓东[1] 刘静 刘璞[1] 刁浩峰[1] 李士学[1] WANG Xiao-dong;LIU Jing;LIU Pu(Spinal Surgery Department,The No.4 People's Hospital of Hengshui,Hengshui 053000,China;不详)

机构地区：[1]衡水市第四人民医院脊柱骨科,河北衡水053000 [2]衡水市人民医院胸心外科,河北衡水053000

出　　处：《中国医学装备》2020年第8期66-70,共5页China Medical Equipment

基　　金：衡水市科技计划(15058)“经椎弓根内侧缘置钉法治疗腰椎退行性疾病的临床研究”。

摘　　要：目的:分析术前CT测量联合术中横突中上1/3定位法行腰椎椎弓根螺钉置入的准确性及可行性。方法:分析行椎板减压内固定术治疗的91例腰椎管狭窄症患者的临床资料,根据采用的椎弓根钉置钉法的不同将其分为观察组(51例)和对照组(40例),观察组采用术前CT测量联合术中横突中上1/3定位法置钉,对照组采用人字嵴法置钉。比较两组在置钉时间、术中透视次数、首次置钉准确率以及螺钉与椎弓根皮质关系的差异性,采用日本矫形外科协会(JOA)评分评价神经功能恢复情况。结果:置钉时间及术中透视次数相比,两组无显著统计学差异;进钉点选取准确率相比,观察组置钉准确率为94.2%(228/242),对照组为88.8%(167/188),两组比较差异有统计学意义(x^2=4.104,P<0.05)。术后两组患者的JOA评分较术前有明显升高,差异有统计学意义(F=59.967,F=57.662;P<0.05),不同时间点组间比较差异无统计学意义。根据术后腰椎CT扫描获得的椎弓根螺钉与周围皮质的关系,观察组优于对照组,两组比较差异有统计学意义(Z=-2.197,P<0.05)。结论:临床中术前采用CT测量联合术中横突中上1/3定位法置钉,可获得更高的置钉准确率及更好的弓根与螺钉包容关系,可为椎弓根钉的准确置入提供一种新的方法及选择。Objective: To analyze the accuracy and feasibility that preoperative computed tomography(CT) measurement combined with pedicle screw placement of lumbar vertebra with intraoperative transverse mid-up 1/3 point positioning method. Methods: The clinical data of 91 patients with lumbar spinal stenosis who underwent internal fixation with laminectomy. According to the different adopted pedicle screw placement method, these patients were divided into observation group(51 cases) and control group(40 cases). The observation group adopted preoperative CT measurement combined with pedicle screw placement of lumbar vertebra with intraoperative transverse mid-up 1/3 point positioning method, and the control group adopted herringbone ridge method for placing screw. The differences of time of placing screw, intraoperative fluoroscopy frequency, the accuracy of placing screw at the first, and the relationship between the screw and the cortex of vertebral pedicle were recorded and compared, and the scale of Japanese Orthopaedic Association(JOA) was adopted for evaluating the recovery of neural functional of patients. Results: There were no significant differences in the time of placing screw and intraoperative fluoroscopy frequency between the two groups. The accuracy of placing screw of observation group(94.2%, 228/242) was significantly higher than that of control group(88.8%, 167/188)(x^2=4.104, P<0.05). The JOA scores of two groups post operation were significantly higher than those pre operation(F=59.967, F=57.662, P<0.05), respectively. And the difference of different time point between the two groups was no significantly. And the relationship of pedicle screw and surrounding cortex, which obtained from CT scan on lumbar vertebra, of observation group was significantly better than that of control group(Z=-2.197, P<0.05). the relationship between pedicle screw ob CT scan the observation group was superior the control group. Conclusion: The preoperative CT measurement combines with pedicle screw placement of lumbar vertebra

关 键 词：CT扫描 椎弓根螺钉 腰椎管狭窄症 置钉 

分 类 号：R816.8[医药卫生—放射医学]