【摘要】 目的 探讨MSCT在评价先天性脊柱侧弯椎弓根螺钉置入术后位置的应用价值。方法 选择有完整术后CT资料的先天性脊柱侧弯患者25例,共计156枚椎弓根螺钉进行MSCT评价螺钉置入椎弓根的准确性,其中颈椎螺钉43枚,胸椎螺钉81枚,腰骶椎螺钉32枚,观察螺钉在椎弓根内的位置,记录螺钉穿透骨壁的位置、数目和距离。结果 在置入的156枚椎弓根螺钉中,124枚螺钉(79.5%)完全位于椎弓根内,32枚螺钉(20.5%)发生错置,其中23枚螺钉(71.9%)穿破皮质≤2 mm,8枚螺钉(25%)穿破皮质在2～4 mm,1枚(3.1%)穿破皮质≥4 mm。在螺钉穿破椎弓根的方向中,椎弓根外侧壁占46.9%,内侧壁占25%,上壁占12.5%,下壁占15.6%。凸侧共置入螺钉86枚,错置12枚,准确率为86%;凹侧共置入螺钉70枚,错置20枚,准确率为71.4%,凹侧与凸侧螺钉置入准确率比较无统计学差异(P>0.05)。在错置的32枚螺钉中,胸椎椎弓根穿透率明显高于颈椎和腰骶椎(P<0.05),分别为27.2%(22/81).14%(6/43),12.5%(4/32)。结论 MSCT是评价椎弓根螺钉位置的一种重要检查方法,对先天性脊柱侧弯患者术后进行MSCT检查具有重要的临床意义。更多还原

【Abstract】 Objective To study the value of MSCT in evaluating the position of the screw after pedicle screw placement for congenital scoliosis.Methods 25 patients with congenital scoliosis with complete CT data were chosen.One hundred and fifty-six screws were placed in 25 patients,including 43 screws in cervical spine,81 in thoracic spine,and 32 in lumbar-sacral spine.The relative position of the screws to the pedicle,the distances of cortical perforation by the screws and their numbers were observed.Results In156 pedicle screws inserted,124 screws(79.5%) were fully lain within the pedicle,and the other 32 screws(20.5%) were misplaced,including penetrating cortical distance≤2 mm in 23 screws(71.9%),2 to 4 mm in 8(25 %),and≥4 mm in 1(3.1%).In the penetrating directions of screws,there were 15 screws(46.9 %)in the lateral wall,8 screws(25%) in the medial wall,4 screws(12.5 %) in the upper wall and 5 screws(15.6%)in the lower wall.Of the total 86 pedicle screws inserted on the convex side,12 were misplaced,with the accurate rate of 86%.70 screws were inserted on the concave side,20 of which were misplaced,with the accurate rate of71.4%.There was no statistical difference between the convex and concave side as to the accurate rate of screw implantation(P>0.05).The penetrating rate of the pedicle by screws was higher in the thoracic(27.2%) compared with the cervical(14%) and lumbar-sacral(12.5%) spine.Conclusion MSCT is an effective examination to assess the screw’ s position,and it has important value for patients with congenital scoliosis after operation with screw placement.更多还原