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[1]王亞楠,李青松,謝夢琦,等.椎弓根螺釘內(nèi)固定術(shù)中應(yīng)用錐束CT掃描評估椎弓根螺釘位置及椎弓根破壞情況的準(zhǔn)確性臨床研究[J].中醫(yī)正骨,2017,29(10):25-29.
　WANG Yanan,LI Qingsong,XIE Mengqi,et al.Clinical study on accuracy of cone beam computed tomography scanning in evaluating location of pedicle screws and severity of damage of pedicle of vertebral arch in surgery of pedicle screw internal fixation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):25-29.
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椎弓根螺釘內(nèi)固定術(shù)中應(yīng)用錐束CT掃描評估椎弓根螺釘位置及椎弓根破壞情況的準(zhǔn)確性臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年10期
頁碼:
25-29
欄目:
臨床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Clinical study on accuracy of cone beam computed tomography scanning in evaluating location of pedicle screws and severity of damage of pedicle of vertebral arch in surgery of pedicle screw internal fixation
作者:
王亞楠; 李青松; 謝夢琦; 郭明明; 孟令志; 王琪
中國人民解放軍沈陽軍區(qū)總醫(yī)院,遼寧 沈陽 110801
Author(s):
WANG Yanan; LI Qingsong; XIE Mengqi; GUO Mingming; MENG Lingzhi; WANG Qi
General Hospital of Shenyang Military District of PLA,Shenyang 110801,Liaoning,China
關(guān)鍵詞:
體層攝影術(shù); X線計算機;  錐束CT;  椎弓根螺釘
Keywords:
Key words tomography; X-ray computed;  cone beam computed tomography;  pedicle screw
摘要:
目的:探討椎弓根螺釘內(nèi)固定術(shù)中應(yīng)用錐束CT掃描評估椎弓根螺釘位置及椎弓根破壞情況的準(zhǔn)確性。方法:2015年10月至2017年6月收治43例因脊柱病變需接受椎弓根螺釘內(nèi)固定手術(shù)的患者,腰椎退行性疾病21例、胸腰椎骨折9例、胸腰椎腫瘤11例、脊柱畸形2例,分別經(jīng)后路進(jìn)行椎間融合、骨折復(fù)位內(nèi)固定、腫瘤切除內(nèi)固定和脊柱矯形手術(shù)。術(shù)中置入椎弓根螺釘后用Artis Zeego系統(tǒng)行錐束CT掃描,了解螺釘位置和椎弓根破壞情況,必要時及時進(jìn)行調(diào)整。術(shù)后1周內(nèi)所有患者均采用CT進(jìn)行病變部位掃描,了解螺釘位置和椎弓根破壞情況。分別根據(jù)術(shù)中錐束CT掃描圖像和術(shù)后CT掃描圖像采用Gertzbein分級系統(tǒng)評估螺釘位置和椎弓根破壞情況。結(jié)果:43例患者均順利完成手術(shù),手術(shù)時間(224.2±47.1)min,術(shù)中出血(482.6±471.6)mL。43例患者共置入262枚椎弓根螺釘,胸椎置釘104枚、腰椎置釘142枚、骶骨(S1節(jié)段)置釘16枚。無1例患者因椎弓根螺釘誤置行二次手術(shù)調(diào)整釘位,未發(fā)生椎弓根螺釘置入導(dǎo)致的神經(jīng)損傷。置入的262枚螺釘中,僅10枚螺釘根據(jù)術(shù)中錐束CT圖像評估的分級結(jié)果與根據(jù)術(shù)后CT圖像評估的分級結(jié)果不一致。根據(jù)術(shù)中錐束CT圖像評估的分級結(jié)果與根據(jù)術(shù)后CT圖像評估的分級結(jié)果具有非常好的一致性(Kappa=0.804,P=0.000)。結(jié)論:椎弓根螺釘內(nèi)固定手術(shù)中,應(yīng)用錐束CT掃描評估螺釘位置和椎弓根破壞情況,準(zhǔn)確性較高。
Abstract:
ABSTRACT Objective:To explore the accuracy of cone beam computed tomography(CT)scanning in evaluating the location of pedicle screws and the severity of damage of pedicle of vertebral arch in the surgery of pedicle screw internal fixation.Methods:Forty-three patients were recruited from October 2015 to June 2017 and they needed pedicle screw internal fixation for treatment of spinal lesions,including lumbar degenerative disease(21),thoracolumbar vertebral fracture(9),thoracolumbar tumors(11)and spinal deformity(2).Intervertebral fusion,fracture reduction and internal fixation,tumor removal and internal fixation and spinal orthopedic surgery were performed on patients respectively through posterior approach.Cone beam CT scanning was performed on all patients using Artis Zeego system after pedicle screws were inserted into the pedicle of vertebral arch to know about the location of pedicle screws and the severity of damage of pedicle of vertebral arch.The location of pedicle screws were adjusted in time if necessary.The diseased region was scanned in all patients by using CT within one week after surgery to know about the location of pedicle screws and the severity of damage of pedicle of vertebral arch.The location of pedicle screws and the severity of damage of pedicle of vertebral arch were evaluated by using Gertzbein rating system according to the intraoperative cone beam CT scanning images and postoperative CT scanning images respectively.Results:The surgeries were finished successfully in all patients,and the operative time and intraoperative blood loss were 224.2+/-47.1 min and 482.6+/-471.6 ml respectively.A total of 262 pedicle screws were inserted into pedicles of vertebral arch in 43 patients,including thoracic pedicle screws(104),lumbar pedicle screws(142)and sacral pedicle screws at S1 segment(16).No patient underwent reoperation for pedicle screw location correction,and no nerve injury caused by pedicle screw insertion was found.The intraoperative cone beam CT images were inconsistent with the postoperative CT images in the rating results for only 10 of 262 screws.The rating results showed very good consistency between intraoperative cone beam CT images and postoperative CT image(Kappa=0.804,P=0.000).Conclusion:The location of pedicle screws and theseverity of damage of pedicle of vertebral arch can be evaluated accurately using cone beam CT scanning in the surgery of pedicle screw internal fixation.

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備注/Memo

備注/Memo:
基金項目:中國博士后科學(xué)基金面上項目(2015M582821); 遼寧省自然科學(xué)基金(201602794) 通訊作者:王琪 E-mail:[email protected]
更新日期/Last Update: 2018-03-10