【摘要】 目的:探讨螺旋形导针配合双侧斜位X线片判断颈椎椎弓根螺钉置入孔道准确性的可行性。方法:在干燥人C3￣C7标本的椎弓根峡部环扎钢丝,拍摄X线片。做出通过椎弓根中央及破坏椎弓根内、外侧壁种孔3道,插入螺旋形导针,拍摄X线片。分别采用前后位与单侧斜位X线片相结合、单侧斜位X线片及双侧斜位X线片判定导针置入位置,比较X线片判定结果与实际所做孔道的符合率。结果:斜位X线片上,椎弓根椭圆形影是由椎弓根峡部形成的,螺旋形导针在判断椎弓根置入孔道位置时,双侧斜位X线片法的敏感性、特异性和准确性高于前后位与单侧斜位片结合法和单侧斜位片法。前后位与单侧斜位X线片相结合、单侧斜位X线片、双侧斜位X线片三种读片方法判定导针置入位置准确性分别为75.78%、88.89%、93.05%,三者之间存在显著性差异(P<0.05)。判断位于椎弓根中央、穿破内侧椎弓根皮质和穿破外侧皮质这3种孔道位置时,双侧斜位X线片法的准确性分别为90.21%、90.76%、94.74%,高于其它两种读片方法(P<0.05)。结论:螺旋形导针配合双侧斜位X线片用于判断颈椎椎弓根螺钉置入孔道位置的准确性是可行的。更多还原

【Abstract】 Objective:To evaluate the accuracy of cervical pedicle screw pilot holes placement by bilateral oblique X-ray films with the spiral wires as the guide pin.Method:Wire markers were placed on the waist of the pedicle(C3~C7),and then radiographs were taken.The pedicle screw pilot holes were drilled within the center of the pedicle,penetrated the lateral and medial pedicle walls in human dried cervical vertebrae.Spiral wires were placed in the holes,then the posteroanterior(PA) and oblique radiographs were taken.The radiographs were taken in three positions,the posteroanterior radiograph combined with unilateral oblique one (PAUO),unilateral oblique films(UO),and bilateral oblique films(BO).The results were analyzed by the statistical software.Result:The oval image of the pedicle on oblique radiographs was the waist.The sensitivity,specificity and accuracy of BO were significantly higher than those of PAUO and UO.The accuracy of using PAUO,UO and BO method to detect pedicle pilot hole placement was 75.78%,88.89% and 93.05%,and there was significantly different(P<0.05).The accuracy of BO method to assess intrapedicle pilot hole,violated medial pedicle pilot hole and violated lateral pedicle pilot hole was 90.21%,90.76% and 94.74% respectively,and these were much higher than other two methods(P<0.05).Conclusion:The bilateral oblique X-ray films with the spiral guid wires may be used to assess the accuracy of cervical pedicle pilot hole placement.更多还原