摘要
目的通过CT三维重建技术模拟腰椎皮质骨螺钉(cortical bone trajectory,CBT)植钉,明确植钉起点及方向。方法选取2017年2月—2018年4月24例患者腰椎CT作为研究对象。其中男7例,女17例;年龄37~68岁,平均50.4岁。将患者CT DICOM格式数据导入Mimics 16.0软件中,建立腰椎三维模型;运用软件建立直径5 mm圆柱体模拟腰椎CBT,根据植钉方案不同将研究分为A、B、C 3组,其钉道轨迹分别经过椎弓根峡部上缘、内侧缘、下缘。将模拟螺钉与腰椎相交部分标记为感兴趣区(region of interest,ROI)并生成蒙板,应用Mimics 16.0软件自动测量每个节段ROI的平均CT值[亨氏单位(Hounsfield unit,HU)]、钉道长度,另外分别测量钉道头倾角、外倾角。以横突根部最下缘水平线与腰椎峡部外侧缘交点F作为标志点,测量A、B、C方案钉道起点与F点水平及垂直距离,观察3种方案钉道与关节突关节和棘突位置的关系。结果A方案ROI平均HU最高,最大值出现在L4;B方案钉道长度最长,最大值出现在L5;C方案钉道头倾角最大,最大值出现在L4;B方案钉道外倾角最大,最大值出现在L3。B方案组钉道长度和外倾角均显著大于A、C组(P<0.05);A、B、C方案组头倾角逐渐增加,各组间比较差异均有统计学意义(P<0.05);3个方案组间ROI平均HU比较差异均无统计学意义(P>0.05)。A方案组74.48%(143/192)螺钉的植钉起点水平方向距F点-2~4 mm,垂直方向距F点6~14 mm,头倾角(14.64±2.77)°,外倾角(6.55±2.09)°;B方案组84.58%(203/240)螺钉的植钉起点水平方向距F点1~6 mm,垂直方向距F点1~5 mm,头倾角(26.93±2.21)°,外倾角(10.29±2.46)°;C方案组85.94%(165/192)螺钉的植钉起点水平方向距F点-2~3 mm,垂直方向距F点-2~4 mm,头倾角(33.50±3.69)°,外倾角(6.47±2.48)°。结论L1~L5 CBT植钉起点宜选择B方案,位于横突根部最下缘水平线与腰椎峡部外侧缘交点水平向内1~6 mm,垂直向上1~5 mm,头倾角(26.93±2.21)°,外倾角(10.
Objective CT three-dimensional reconstruction technology was used to simulate the placement of the lumbar cortical bone trajectory(CBT),to determine the starting point and direction of the screw trajectory.Methods Between February 2017 and April 2018,24 patients with lumbar CT were selected as the study object.There were 7 males and 17 females,with an average age of 50.4 years(range,37-68 years).The CT DICOM data of patients were imported into Mimics 16.0 software,and the three-dimensional model of lumbar spine was established.A 5 mm diameter cylinder was set up to simulate the CBT by using Mimics 16.0 software.According to the different implant schemes,the study was divided into groups A,B,and C,the track of the screw respectively passed through the upper edge,the medial edge,and the lower edge of the isthmus of the pedicle.The intersection of simulated screw and lumbar spine was marked as region of interest(ROI)and a mask was generated.The average CT value[Hounsfield unit(HU)]and the screw length of ROI were automatically measured by Mimics 16.0 software.In addition,the head inclination angle and head camber angle of the screw were measured respectively.Point F was the intersection of the level of the lowest edge of the transverse process and the lumbar isthmus periphery.The horizontal and vertical distance between point F and the starting point were measured,and the relationship between the three schemes and the position of the zygapophysial joint and spinous process was observed.Results Plan A has the highest ROI average HU,with the maximum value appearing in L4;plan B has the longest screw length,with the maximum value appearing in L5;plan C has the largest nail track head inclination angle,with the maximum value appearing in L4;plan B has the largest nail track head camber angle,with the maximum value appearing in L3.The screw length and head camber angle of the nail in group B were significantly greater than those in groups A and C(P<0.05);the head inclination angle in groups A,B,and C was gradually increa
作者
黄镇
孙宁
任佳彬
李瑞
刘鑫
李岳飞
毕经纬
孙兆忠
HUANG Zhen;SUN Ning;REN Jiabin;LI Rui;LIU Xin;LI Yuefei;Bl Jingwei;SUN Zhaozhong(Department of Spine Surgery,Affiliated Hospital of Binzhou Medical University,Binzhou Shandong,256600,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第2期162-167,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家重点研发计划资助项目(2017YFC0114002)
山东省自然科学基金资助项目(ZR2017LH021)
滨州医学院科技计划项目(BY2018KJ03)~~
关键词
皮质骨螺钉
腰椎
CT三维重建
骨质疏松
Cortical bone trajectory
lumbar
CT three-dimensional reconstruction
osteoporosis
