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目的:探讨螺旋CT测量辅助下颈椎椎弓根个体化置钉的准确性。方法:成人颈椎标本10具行螺旋CT扫描重建,在其多平面截面图像上设计出理想进钉路线,此路线在后方侧块上的投影点(O点)即为理想的进钉点,测量出O点与侧块外缘的距离(HO),或到横突根部的距离(HT),与侧块下缘的距离(HL),或与侧块上缘的距离(HU)。同时测量此路线与椎体中轴线的夹角(Am)以及与椎体上终板的夹角(AE);测量椎弓根峡部松质骨核心的长径(IL)与短径(IS),并测量其向内倾斜角度(f)。在标本上依据上述测量得到的数据找出椎弓根内固定的进钉点即O点,并根据测量的角度确定进钉方向后插入克氏针模拟置钉。将置钉后的标本进行CT扫描,判断其准确性。结果:共置入98枚克氏针,89枚(90.8%)完全在椎弓根内,9枚(9.2%)穿破椎弓根。结论:利用螺旋CT测量的数据辅助下颈椎椎弓根置钉有较高的准确性,但仍有一定的椎弓根穿破率。
Objective: To investigate the accuracy of pedicle screw-assisted pedicle screw placement assisted by spiral CT. Methods: The adult cervical spine 10 was reconstructed by spiral CT scan, and the ideal advancing nail route was designed on the multi-plane cross-sectional image. The projection point (O point) of the route on the posterior mass was the ideal entry point. The distance (OO) from the outer edge of the lateral block (HO), the distance to the root of the lateral root (HT), the distance to the lower edge of the lateral block (HL) or the distance from the upper edge of the lateral block (HU). At the same time, the angle between this route and the axis of the vertebral body (Am) and the angle between the route and the end plate of the vertebral body (AE) were measured. The long axis (IL) and short axis (IS) , And measure its inward tilt angle (f). According to the data obtained from the above measurement, the pedicle screw fixation point O is identified and the nail insertion direction is determined according to the measurement angle. The nail specimens will be CT scan to determine the accuracy. Results: A total of 98 Kirschner wires were implanted, 89 (90.8%) were completely in the pedicle, and 9 (9.2%) were perforated. CONCLUSIONS: The accuracy of spiral pedicle screw placement assisted by data from spiral computed tomography is high, but there is still a certain rate of pedicle screw penetration.