摘要
目的对比应用螺旋CT三维重建辅助手术技术与传统徒手技术置入胸椎椎弓根钉的一次性成功率和准确性。方法32例胸椎椎弓根钉内固定病例,分为螺旋CT三维重建技术辅助手术组(A组)和传统技术手术组(B组)。其中A组13例,行螺旋CT扫描后进行三维重建,开展术前计划及个体化测量以指导手术,置钉31椎节共60枚;B组19例,采用传统徒手技术置钉45椎节共88枚。所有病例术中记录钉置入的一次性成功率,术后再次进行螺旋CT扫描三维重建评估置钉准确性,数据按P≤0.05的显著性标准,应用四格表χ2检验进行统计学分析。结果A、B两组的一次性置入成功率分别为75.0%(45/60)和53.4%(47/88)(P=0.008);椎弓根穿破率分别为46.7%(28/60)和60.2%(53/88)(P=0.104);椎弓根穿破≥2mm的发生率分别为1.7%(1/60)和14.8%(13/88)(P=0.007)。结论利用螺旋CT三维重建技术辅助胸腰椎椎弓根钉内固定手术,可以显著提高椎弓根钉置入的一次性成功率和准确性。
Objective To compare the one-time success rate and accuracy of thoracic pedicle screw placement achieved by screw insertion assisted by spiral CT image three-dimensional （3D） reconstruction technique and the conventional free hand placement technique. Methods Thirty-two patients scheduled for thoracic pedicle screw placement were divided into Group A （with spiral CT image 3D reconstruction-assisted pedicle screw placement） and Group B （ with conventional free hand technique ）. Thirteen cases of Group A had been scanned by spiral CT before surgery, and 3D images were reconstructed to plan operation and individualized measures were used to guide insertion of 60 pedicle screws in 31 levels. In Group B 88 pediele screws in 45 levels were inserted with conventional free hand technique for 19 cases. To measure the accuracy of thoracic pedicle screw placement,all cases in both groups were scanned by spiral CT and 3D images were reconstructed after surgery. Statistical analysis was performed using the Pearson Chi-square Test（P≤0.05）. Results The one-time success rate of thoracic screw placement in Group A and Group B was 75.0% （45/60） and 53.4% （47/88） respeetively（P = 0. 008） ,with the pediele perforation rate being 46.7% （ 28/601 and 60.2% （ 53/88 ） respectively（ P = 0. 104 ） , and the pediele perforation rate of more than 2mm was 1.7% （1/60） and 14.8% （13/88） （ P = 0. 007 ） , respectively. Conclusion By using spiral CT image 3D reconstruction technique assisting thoracic pediele screw placement,the one-time success rate and accuracy of thoracic screw placement can be improved significantly.
出处
《创伤外科杂志》
2009年第2期119-123,共5页
Journal of Traumatic Surgery
基金
云南省自然科学基金资助项目(NO2007C242M)
云南省教育厅基金项目(NO07y847c)
关键词
计算机体层摄影
三维重建
胸椎
椎弓根钉
spiral computed tomography
three-dimensional reconstruction
thoracic vertebra
pedicle screws
