椎弓根超声探测仪的研制与实验研究  

Development and experimental study of pedicle ultrasonic detector

作　　者：曾忠友[1] 张建乔[1] 宋永兴[1] 俞伟[1] 范时洋 裴斐[1] 籍剑飞[1] Zeng Zhongyou;Zhang Jianqiao;Song Yongxin;Yu Wei;Fan Shiyang;Pei Fei;Ji Jianfei(The Second Department of Orthopaedics,Hospital of Coast Guard General Corps of Armed Police Forces,Jiaxing 314000,China)

机构地区：[1]武警部队骨科中心,武警海警总队医院骨二科,嘉兴314000

出　　处：《中华实验外科杂志》2020年第9期1695-1699,共5页Chinese Journal of Experimental Surgery

基　　金：浙江省科技厅社会公益项目(2014C33120)。

摘　　要：目的设计、研制椎弓根超声探测仪,并进行活体猪的椎弓根置钉对比。方法利用骨组织与软组织超声阻抗值差异明显的特性,设计将一个5 MHz的、大小为0.6 mm×3.0 mm的微型超声传感器安装于椎弓根钻头的尖端,在使用钻头进行椎弓根钻孔时发射超声波并接收回波,经放大处理,并转换成数字信号,最后以图像的形式展现,以实时监测和引导椎弓根的钻孔和螺钉的植入。首先通过猪腰椎标本获取骨组织和软组织的声阻抗值参数,总结不同组织声阻抗特点及图像规律,然后使用超声钻头在猪腰椎标本上模拟椎弓根穿刺,进一步验证、完善数学模型和图像软件,实现整机成型。使用6只成年大白猪,选择腰1~腰5双侧进行经椎弓根置钉,左侧为徒手置钉,右侧为椎弓根超声探测仪引导下置钉,观察并对比两侧置钉的操作时间和螺钉位置不良率。两种置钉方法所用时间和螺钉位置不良率的对比采用成组设计资料的t检验,两种置钉方式的椎弓根螺钉位置的对比采用χ2检验。结果体外新鲜猪骨骼标本中的实验表明,椎弓根超声探测仪在引导椎弓根穿刺和置钉方面具有可行性。6只成年大白猪两侧置钉结果显示,两侧置钉操作的时间分别为徒手侧平均(11.21±0.53)min,椎弓根超声探测仪引导侧平均(11.75±0.59)min,两组对比差异无统计学意义(t=1.628,P>0.05)。两侧椎弓根螺钉位置情况:左侧(徒手置钉侧)螺钉位置Ⅰ度18枚、Ⅱ度7枚、Ⅲ度5枚,螺钉位置不良率40%;右侧(椎弓根超声探测仪引导下置钉侧)螺钉位置Ⅰ度28枚、Ⅱ度2枚、Ⅲ度0枚,螺钉位置不良率6.67%。螺钉位置和螺钉位置不良率两侧对比差异均有统计学意义(χ2=11.173,P<0.01;t=9.591,P<0.01),即椎弓根超声探测仪引导下的置钉准确率明显高于徒手置钉组。结论无论是体外试验或活体猪在体实验均证实,椎弓根超声探测仪具有操作简单、实用性强�Objective To design and develop the pedicle ultrasonic detector,and compare pedicle screw placement in pigs.Methods According to the ultrasonic and magnetic difference between the bone and soft tissues,a 5 MHz micro-ultrasonic sensor with a size of 0.6 mm×3.0 mm was designed to be mounted on the tip of the pedicle drill bit,and the ultrasonic wave was transmitted and received when the pedicle was drilled using the drill bit.The echoes were amplified,converted to digital signals,and finally presented as images to monitor and guide the pedicle drilling and screw placement in real time.First,the acoustic impedance parameters of bone tissue and soft tissue were obtained from porcine lumbar spine specimens,and the characteristics of the acoustic impedance of different tissues and the image regularity were summarized.Then the ultrasonic drill was used to simulate pedicle puncture on a pig lumbar spine specimen,further the mathematical model and image software verified and improved,and the whole machine shaping was achieved.Six adult large white pigs were purchased,and the pedicle screws were placed on both sides of L1-L5 by freehand on the left side,and under the guidance of the pedicle ultrasonic detector on the right side.The operating time of the nailing and the misplacement rate of pedicle screws were observed.Results The experiment showed the feasibility of pedicle ultrasonic detector in pedicle puncture and pedicle screws placement.The time of pedicle screws placement was meanly(11.21±0.53)min in the freehand side and(11.75±0.59)min in the pedicle ultrasonic detector side,and the difference was not statistically significant(t=1.628,P>0.05).In the freehand side,there were 18 pedicle screws of degreeⅠ,7 of degreeⅡand 5 of degreeⅢ,with a misplacement rate of 40%.In the pedicle ultrasonic detector side,there were 28 pedicle screws of degreeⅠ,2 of degreeⅡand none of degreeⅢ,with a misplacement rate of 6.67%.The accuracy rate of pedicle screws placement in pedicle ultrasonic detector side was significant

关 键 词：椎弓根 螺钉 超声 监测 

分 类 号：R687.3[医药卫生—骨科学]