基于CTA多平面重建对后路寰枢椎经关节螺钉与枢椎椎弓根螺钉固定术的安全性比较  

Comparison of Safety Between Posterior C1-C2 Transarticular and C2-Pedicle Screws Basedon CT Multiplanar Reconstruction

作　　者：黄觅 李晓兰 郭亮 陈思浩 王叶 HUANG Mi;LI Xiao-lan;GUO Liang;CHEN Si-hao;WANG Ye(Department of Radiology,the College Hospital of Chongqing Medical University,Chongqing 401331,China;Department of Orthopaedics,the College Hospital of Chongqing Medical University,Chongqing 401331,China)

机构地区：[1]重庆医科大学附属大学城医院放射科,重庆401331 [2]重庆医科大学附属大学城医院骨科,重庆401331

出　　处：《中国CT和MRI杂志》2021年第2期136-139,共4页Chinese Journal of CT and MRI

基　　金：重庆市卫生计生委医学科研项目(2016MSXM059)。

摘　　要：目的通过CTA多平面重建(MPR)比较后路寰枢椎经关节螺钉固定术(TAS)与枢椎椎弓根螺钉固定术(PS)的安全性。方法回顾性分析行头颈CTA扫描的患者63例,在MPR上模拟两种螺钉置入,并比较两种方法对枢椎椎动脉沟(C2 VAG)的侵犯率,同时记录最佳置钉角度。将患者根据高骑动脉(HRVA)、椎弓根狭窄(NP)及枢椎段椎动脉(IAVA)分型进行分组,采用χ2检验分析各种分组中两种手术方法对C2 VAG侵犯率的差别,用oneway ANOVA对两种方法置钉角度与IAVA分型之间的关系进行分析。结果在总研究人群中,TAS对C2 VAG侵犯率为23.8%,PS为29.4%,两者的差异无统计学意义(P=0.12)。在HRVA中,TAS对C2 VAG侵犯率(66.7%)显著低于PS(87.9%)(P=0.03),而在NP病例中,TAS(77.8%)与PS(88.9%)对C2 VAG侵犯率的差异无统计学意义(P=0.16)。TAS、PS对C2 VAG侵犯及HRVA与IAVA分型之间差异具有显著性(P<0.001)。在M-a型当中,TAS(84.2%)与PS(94.7%)对C2 VAG侵犯率的差异无统计学意义(P=0.16)。椎动脉的走行越向内向上,PS的内倾角越大,但不影响TAS的置钉角度。结论TAS和PS对椎动脉侵犯率较高,存在同样的风险;在HRVA中,TAS相对更加安全。基于MPR可在术前综合评估解剖参数及置钉角度,为上颈椎手术提供更安全的选择。Objective To compare the safety between C1-C2 transarticular and C2-Pedicle screws via the CT Multiplanar Reconstruction of vertebral artery CT angiography(MPR).Methods Retrospective analysis 62 patients underwent head and neck computed tomography angiography examination.Simulate the placement of transarticular and pedicle screws using MPR,then compare the frequency of C2 vertebral artery groove(C2 VAG)violation by the two different fixation methods,and record the safe range of medial convergence angle and sagittal angle of the two ways.Based on the MPR,the general population were classified in the subset of those with narrow pedicles(NP),with high-riding vertebral arteries(HRVA)and with the different subtypes of Intra-axial vertebral artery(IAVA).The differences between NP、HRVA、IAVA types and C2 VAG violation were analyzed with the method of χ^2 test,and using the one-way ANOVA analysis between the angles and IAVA types.Results Overall,25%of TASP and 29%of PSP violated the C2 VAG without a significant difference between the two groups(P=0.12).Among those with HRVA,C2 VAG violation was significantly lower(P=0.03)with TAS than with PS.Among those with NP,C2 VAG violation was high in both groups but without a significant difference between the two types of screws.The subtype IAVA M-a consisted most of NP,HRVA and C2 VAG violation of two methods,which account for 44.4%,51.5%,48.6%and 53.3%respectively.There was a significant difference between NP and HRVA(P<0.001).There was also a significant difference between NP and HRVA violations to the C2 VAG(P<0.001),as well as the C2 VAG violations,NP and HRVA between IAVA(P<0.001).Conclusion Neither method has an inherently higher anatomic risk of C2 VAG violation.However,in the HRVA,TAS is significantly safer than PS.

关 键 词：CTA 多平面重建 螺钉固定术 安全性 比较 

分 类 号：R445.3[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]