【摘要】 目的:观察胸腰段椎弓根CT测量在椎弓根螺钉内固定中的作用,寻找一种个体化椎弓根螺钉置入的方法。方法:选择1999-02/2006-03河北工程大学附属医院收治的T12和/或L1段骨折患者59例,行螺旋CT检查及图像三维重建,重建结束后,得到胸腰段标本的三维图像,通过旋转和切割进行图像处理并测量,模拟出T11～L2的椎弓根形态,根据CT测量椎弓根的实际投照点进行调整,即横断面上椎弓根轴线与矢状位上椎弓根轴线的交点,在确定进钉点时选择下关节突为参照物,选用合适直径的螺钉进行植钉,植入螺钉后,连接棒或板系统。结果:262个椎弓根行植钉术,242个完全在椎弓根内,仅有20个螺钉穿透椎弓根皮质。术后平均随访16.1个月,均无临床并发症的发生,Frankel平均增加1.4级。术后有2例患者出现断钉(3枚),1例患者出现断棒,所植入的螺钉与机体生物相容性好,无不良反应的发生。结论:利用三维CT测量的数据辅助,严格按照个体化的椎弓根的轴线方向植钉,在置钉时应考虑到螺钉本身直径的因素,可以提高植钉的成功率。更多还原

【Abstract】 AIM: To observe the role of spinal CT measurement in transpedicular screw fixation of thoracolumbar vertebral arch, and seek a personalized method of transpedicular screw fixation. METHODS: Three-dimensional (3D) CT measurement and image reconstruction were made on 59 patients of vertebral fracture in L1 and/or T12, who were treated in Affiliated Hospital to Hebei University of Engineering from February 1999 to March 2006. 3D image was processed with rotation and cutting to stimulate the topography of vertebral arch in T11-L2. The experiment was based on the factual projection of vertebral arch, which was the intersection point of axis line on cross section and sagittal section. Suitable screws were chosen to insert according to the liner parameters of pedicle, then the system of pole or board was linked. RESULTS: Totally 262 pedicles of vertebral arch were inserted with screws, 242 cases were entirely located within the pedicle, while only 20 screws penetrated cortex. All postoperative patients were followed up for 16.1 months on average. No clinical complication was found, and Frankel rank increased 1.4 degree. Two cases appeared broken screw (3 screws) and one case presented broken pole, indicating good biocompatibility between screws and organism, without adverse effect. CONCLUSION: The insertion of pedicle screw is safe on the base of 3D CT measurement, while transpedicular screw fixation must be strictly operated according to the axis of the pedicle. At the same time, we should consider the diameter of the screw so as to improve the accuracy rate of transpedicular screw fixation.更多还原