基于CT三维重建的青少年L5峡部裂直接修补螺钉固定手术相关解剖学参数的研究  

Anatomic parameters related to direct screw repair for L5 isthmic lumbar spondylolysis in adolescents based on CT three-dimensional reconstruction measurement

作　　者：张昌盛 潘其鹏 姚杰 朱卉敏 孔凡国 周全 Zhang Changsheng;Pan Qipeng;Yao Jie;Zhu Huimin;Kong Fanguo;Zhou Quan(Department of Minimally Invasive Spine Surgery,Luoyang Orthopedic Hospital of Henan Province/Orthopedic Hospital of Henan Province,Zhengzhou 450000,China;Department of Surgery of Spine and Spinal Cord,Henan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院脊柱微创外科,郑州450000 [2]河南省人民医院脊柱脊髓外科,郑州450000

出　　处：《中华解剖与临床杂志》2024年第9期592-596,共5页Chinese Journal of Anatomy and Clinics

基　　金：河南省中医药科学研究专项(20-21ZY1058);洛阳市医疗卫生科技计划项目(1930010A)。

摘　　要：目的探讨基于CT影像三维重建测量的青少年L5峡部裂患者直接修补螺钉固定手术中置钉的相关解剖学参数。方法病例系列报告。选取河南省洛阳正骨医院2018年7月—2021年6月青少年L5峡部裂患者27例,其中男18例、女9例,年龄12~19(14.9±1.9)岁。收集患者腰椎冠状面、矢状面和横断面CT影像资料。对CT影像进行多平面重组并测量L5椎板螺钉进钉长度、峡部皮质外径、进钉点距棘突正中水平距离、矢状面头偏角、冠状面外偏角。利用Mimics软件重建L5峡部裂模型,并按照CT测量数据进行模拟置钉,观察和评估置钉结果。结果27例青少年L5峡部裂患者,54个峡部均按理想进钉点和钉道轨迹进行测量。L5椎板螺钉进钉长度为(31.83±1.48)mm,左、右两侧分别为(31.88±1.67)、(31.79±1.26)mm;峡部皮质外径为(7.29±0.62)mm,左、右两侧分别为(7.26±0.66)、(7.31±0.57)mm;进钉点与棘突的正中水平距离为(14.43±1.24)mm,左、右两侧分别为(14.41±1.50)、(14.45±0.89)mm;矢状面头偏角为31.64°±2.95°,左、右两侧分别为31.46°±3.28°、31.83°±2.57°:以上指标左、右侧比较差异均无统计学意义(P值均>0.05)。冠状面外偏角为4.26°±2.89°,左、右两侧分别为4.13°±2.24°、4.39°±1.92°,差异有统计学意义(t=2.49,P=0.020)。利用Mimics软件按照上述数据进行模拟置钉,螺钉顺利进入且未突破或损伤骨皮质。结论CT三维重建下模拟青少年L5峡部裂患者直接修补螺钉固定技术置钉准确、安全。据此测量解剖学参数提示,其理想进钉点在椎板下缘的中点,适用直径4.5 mm、长度30.0 mm的螺钉固定。Objective This study aimed to investigate the anatomic parameters of nail placement during direct screw repair in adolescent patients with L5 isthmus based on CT 3D reconstruction.Methods A total of 27 adolescent patients with L5 isthmus were selected from the Radiology Department of Luoyang Orthopaedic Hospital,Henan Province,from July 2018 to June 2021,including 18 males and 9 females,aged 12-19(14.9±1.9)years.Coronal,sagittal,and cross-sectional CT images of the lumbar spine were collected.Multi-plane CT data were reconstructed,and the length of L5 laminae screw insertion,the outer diameter of isthmus cortex,the horizontal distance between insertion point and median spinal process,the declination angle of sagittal plane,and the declination angle of coronal plane were measured.Mimics software was used to reconstruct the L5 isthmus model,and the nail placement was simulated in accordance with the measured CT data.The results were observed and evaluated.Results In the 27 adolescent patients with L5 isthmus,54 isthmuses were measured in accordance with the ideal insertion point and nail-path trajectory.The screw insertion length of L5 laminae was(31.83±1.48)mm,and the left and right sides were(31.88±1.67)and(31.79±1.26)mm,respectively.The outer diameter of the isthmic cortex was(7.29±0.62)mm,and the left and right sides were(7.26±0.66)and(7.31±0.57)mm,respectively.The median distance between the insertion point and spinous process was(14.43±1.24)mm,and the left and right sides were(14.41±1.50)and(14.45±0.89)mm,respectively.The declination angle of the sagittal plane was 31.64°±2.95°,the left and right sides were 31.46°±3.28°and 31.83°±2.57°,respectively.No statistically significant differences were found between the left and right sides of the above indices(all P values>0.05).The average outward declination angle of the coronal plane was 4.26°±2.89°,and the left and right sides were 4.13°±2.24°and 4.39°±1.92°,respectively,and the difference was statistically significant between the left

关 键 词：椎管闭合不全 L5峡部裂 青少年 直接修补螺钉 CT三维重建 影像学测量 解剖学参数 

分 类 号：R726.8[医药卫生—儿科]