【摘要】 目的用CT钟点位观察法观察下颈椎椎弓根钉位置的价值。方法取新鲜骨韧带颈椎标本10具,徒手置入C3~7椎弓根钉100枚,并对螺钉位置进行CT和解剖观察,CT观察采用钟点位观察法和横断位观察法,其结果与解剖直视观察结果相比较。临床置入99枚下颈椎椎弓根钉,术后进行临床和CT观察,用CT钟点位观察法和横断位观察法评价螺钉的位置。结果实验中直视观察、横断位观察法和钟点位观察法分别有有51枚、64枚和57枚螺钉穿破椎弓根。在直视观察中已穿破椎弓根壁的螺钉,钟点位观察法中均为穿破,其穿破方位两者吻合,而横断位观察法有2枚螺钉没有被CT扫描捕获,其余穿破的螺钉其穿破的内外侧分布于直视观察下的结果一致。螺钉穿破椎弓根距离统计结果 ,钟点位观察法与直视观察比较,差异无统计学意义(P>0.05),横断位观察法与直视观察比较,差异有统计学意义(P<0.05)。术后临床观察共有1例发生椎动脉供血不足,术后CT观察,横断位观察法和钟点位观察法分别有28和22枚螺钉穿破椎弓根壁,其穿透距离比较,差异无统计学意义(P>0.05)。结论钟点位观察法在判断下颈椎椎弓根钉位置时,比较横断位观察法具有方位直观准确、穿破距离假阳性率低的特点,更真实可靠。更多还原

【Abstract】 Objective To study the value of pedicle coronal clock method in judging the accuracy of the cervical pedicle screw. Methods One hundred pedicle screws with diameter of 3.5 mm were performed from C3-7in ten specimens, then CT scan were done in order to observe the position of screws using three methods: coronal clock method, straight view method and cross-section method. The accuracy of ninety-nine clinical cervical pedicle screws placement were also evaluated using coronal clock method and cross-section method. Results In vitro study, pedicle wall violation was observed in 51 screws using straight view method, in 64 using cross-section method and in 57 using coronary clock method. All malposition of pedicle screw observed by straight view method were also confirmed using coronal clock method. There was significant difference between the straight view method and cross-section method(P <0.05), but no significance was found between coronary clock method and straight view method(P >0.05). The blood flow can be blocked due to screw in 1 case clinically.Pedicle screw violation was found in 28 pedicles using cross-section method, and in 22 screws using coronary method. There was no measuring significance of violation degree of pedicle screw(P >0.05). Conclusion As compared with cross-section method, CT coronary clock method is a new valuable method in evaluating the position of cervical pedicle screw.更多还原