摘要
目的探讨基于螺旋CT影像中钉道位置判断腰椎骨折患者椎弓根置钉的参数变化、准确性及安全性。方法选取2020年1月—2022年1月120例采用螺旋CT设计钉道行腰椎椎弓根置钉的腰椎骨折患者作为观察组,另选取采用传统Weinstein法进行腰椎椎弓根置钉的腰椎骨折患者120例作为对照组。分析观察组螺旋CT测定腰椎椎弓根钉道参数,并对比2组腰椎椎弓根置钉准确率、安全率、完成钉道准备时间及置钉出血量。结果观察组L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度逐渐增大(P<0.05);L 1~4节段入钉点至椎体前缘距离无明显变化,到L 5节段明显减小(P<0.05)。同一椎体左右两侧椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离比较差异无统计学意义(P>0.05)。男性L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离均大于女性(P<0.05,P<0.01)。双侧最小椎弓根宽度为(8.13±0.59)mm,为安全进钉区域,可安全容纳3.5 mm螺钉。术后3 d,复查螺旋CT了解腰椎椎弓根置钉情况,观察组共置入椎弓根螺钉235枚,对照组共置入椎弓根螺钉229枚。观察组置钉准确率为91.49%(215/235)、安全率为99.15%(233/235)均高于对照组置钉准确率72.05%(165/229)、安全率90.39%(207/229)(P<0.05);观察组完成钉道准备时间短于对照组,置钉出血量少于对照组(P<0.01)。结论基于螺旋CT影像中L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离各腰椎节段间及不同性别间存在差异,可为腰椎椎弓根置钉提供解剖依据,能缩短完成钉道准备时间,减少置钉出血量,提高置钉准确性及安全性。
Objective To investigate the parameter change,accuracy and safety of pedicle screw placement in patients with lumbar spinal fractures based on screw channel position in spiral CT images.Methods From January 2020 to January 2022,120 patients with lumbar spinal fractures who underwent pedicle screw placement with spiral CT design were selected as the observation group,and 120 patients with lumbar spinal fractures who underwent pedicle screw placement with traditional Weinstein method were selected as the control group.Spiral CT was used to determine the parameters of lumbar pedicle screw channel in the observation group,and the accuracy and safety of pedicle screw placement,preparation time of screw channels and blood loss during screw placement in the two groups were compared.Results In the observation group,the axis of pedicle was angular with the axis of spinous process in L 1~5 segments,and the width of the pedicle was gradually increased(P<0.05).The distance from the insertion point to the anterior vertebral edge at L 1~4 segments had no significant change,but decreased significantly at L 5 segments(P<0.05).There were no significant differences in the angle between the axis of the pedicle and the axis of the spinous process,the width of the pedicle and the distance between the insertion point and the anterior edge of the vertebral body(P>0.05).The angle between the pedicle axis and the spinous process axis,the width of the pedicle,and the distance from the insertion point to the anterior edge of the vertebral body were greater at L 1~5 segments in males than in females(P<0.05,P<0.01).The minimum pedicle width on both sides was(8.13±0.59)mm,which was a safe entry area and could safely accommodate 3.5 mm screws.At 3 days after surgery,spiral CT was re-performed to understand the pedicle screw placement of lumbar vertebra.A total of 235 and 229 pedicle screws were inserted in the observation group and the control group respectively.The accuracy and safety rates of observation group were 91.49%(215/235)and 99.15%(233/235)respectively,which were higher than those of control group[72.05%(165/229)and 90.39%(207/229)]respectively(P<0.05).The preparation time of screw channels in the observation group was shorter than that in the control group,and the blood loss during screw placement was less than that in the control group(P<0.01).Conclusion The angle between the pedicle axis and the spine process axis,the width of the pedicle,and the distance from the insertion point to the anterior edge of the vertebral body are different among different segments and between different genders in spiral CT images,which can provide anatomical basis for the placement of lumbar pedicle screws,shorten the preparation time of the screw channel,reduce the amount of blood loss,and improve the accuracy and safety of the placement of screws.
作者
李硕
石运力
朱江
王磊
LI Shuo;SHI Yunli;ZHU Jiang;WANG Lei(Department of Radiology,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China)
出处
《转化医学杂志》
2024年第1期68-74,共7页
Translational Medicine Journal
基金
河北省2021年度医学科学研究课题计划项目(20210250)。
