颈胸段前路椎弓根螺钉固定技术的影像学研究及可行性分析

发布时间：2018-02-03 07:50

本文关键词： 颈胸段前路椎弓根影像学　出处：《宁波大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究脊柱颈胸段前路椎弓根螺钉在椎体前面置入的进钉位置和进钉方向,并探讨颈胸段前路椎弓根螺钉置入的可行性。方法:调取自2013年12月至2014年7月行颈椎及上胸椎螺旋螺旋CT扫描示无生理曲度异常、骨质破坏、严重退变的完整影像资料50例,其中男性29例,女性21例,年龄23~61岁,平均37.3岁,在原始连续横断面图像上测量颈胸段椎弓根宽度、椎弓根轴线长度、水平面进针点距离以及进针点所在椎体前缘的分区、椎弓根轴线的外倾角;利用advantage workstation 4.2工作站对原始连续横断面图像进行多平面重建,在重建获得的椎弓根矢状面像测量颈胸段椎弓根高度、椎体前缘高度、矢状面进针点距离以及进针点所在椎体前缘的分区、椎弓根轴线头/尾倾角,记录C6~T2椎弓根轴线在胸骨柄上区、胸骨柄区及胸骨柄下区的分布情况,并进行比较分析。结果:C6~T2椎弓根宽度、高度、椎体前缘高度在性别差异上无统计学意义;C6~T2水平面进针点距离、矢状面进针点距离、椎弓根轴线长度两性差异有统计学意义(P0.5)。C6~T2水平面进针点距离逐渐增大-0.34~4.75mm;C6矢状面进针点距离最小5.18±1.02mm,T2矢状面进针点距离最大9.82±2.28mm。C6~T2椎弓根轴线长度31.01~34.21 mm。相同性别的水平面进针点距离、矢状面进针点距离在不同椎节的差异有统计学意义(P0.5)。C6~T2外倾角、尾倾角在性别差异上无统计学意义,合并两性数据示C6~T2外倾角逐渐减小46.77°~20.02°;椎弓根轴线在矢状位上均尾倾,C6~T1尾倾角逐渐减小18.10°~14.54°,而T2尾倾角最大20.62°±5.04°;C6~T2外倾角、尾倾角在不同椎节的差异有统计学意义(P0.5)。C6、C7椎弓根轴线穿经胸骨柄上区(A区);T1前路椎弓根轴线主要穿经胸骨柄上区(A区)和胸骨柄区(B区);T2前路椎弓根轴线穿经胸骨柄区(B区)和胸骨柄下区(C区)。A、B、C分区结果在性别差别上无显著性差异(P0.05)。结论:在颈胸段不同椎节,前路椎弓根螺钉置入参数存在差异。理论上通过低位下颈椎前方入路可完成C6、C7、个别T1前路椎弓根螺钉的置入,而大部分T1、T2因受限于其前方骨性结构的阻挡,无法通过低位下颈椎前方入路完成前路置钉。
[Abstract]:Objective: to study the position and direction of anterior pedicle screw placement in front of vertebral body. To explore the feasibility of anterior pedicle screw implantation in cervical and thoracic segment. Methods: the spiral CT scan of cervical spine and upper thoracic vertebrae from December 2013 to July 2014 showed no abnormal physiological curvature. There were 50 cases of bone destruction and severe degeneration, including 29 males and 21 females. The age was 2361 years with an average of 37.3 years. The width of cervical and thoracic pedicle, the length of pedicle axis, the distance between horizontal point and the anterior edge of vertebral body, and the angle of external inclination of pedicle axis were measured on the original continuous cross-sectional images. Advantage workstation 4.2 workstation was used to reconstruct the original continuous cross-sectional images. The height of cervical and thoracic pedicle, the height of anterior edge of vertebral body, the distance of insertion point of sagittal plane, the division of anterior edge of vertebral body and the angle of head / tail inclination of pedicle axis were measured in the reconstructed sagittal images. The distribution of the pedicle axis of C _ 6 and T _ 2 in the superior sternum area, the sternal stalk area and the inferior sternum area were recorded and compared and analyzed. Results the pedicle width and height of the pedicle line were compared and analyzed. There was no statistical difference in the height of the anterior edge of the vertebral body between the two sexes. The distance between the point of insertion in horizontal plane and sagittal plane was found in C6 / T 2 plane and sagittal plane respectively. There was significant difference in the length of pedicle axis between the two sexes. The distance of injection point in horizontal plane of P0.5, C6 and T2 gradually increased -0.34 卤4.75 mm. C6 sagittal plane had the smallest distance of 5.18 卤1.02 mm. The maximum distance between the insertion point of T 2 sagittal plane was 9.82 卤2.28 mm. The length of axial line of T 2 pedicle was 31 01 卤34 21 m. The distance of needle point in horizontal plane was the same as that in horizontal plane of the same sex. There were significant differences in the distance between the insertion points of the sagittal plane and the different vertebrae segments. There was no significant difference in the angle of tail inclination between the two sexes. The combined data showed that the external inclination of C6 / T 2 gradually decreased by 46.77 掳to 20.02 掳; In sagittal position, the axis of pedicle decreased gradually from 18.10 掳to 14.54 掳, while that of T2 to 20.62 掳卤5.04 掳. There were significant differences in the external inclination angle and tail inclination angle between C6 and T2 in different vertebrae segments. There was a significant difference in the axis of pedicle of C6C7 through the superior sternum area of the sternum. The anterior pedicle axis of T1 mainly passes through the superior sternum area (area A) and the sternal stalk area (area B). T2 anterior pedicle axis through the sternum area (area B) and the substernal pedicle area (area C). There was no significant difference in gender difference in the results of division C (P 0.05). Conclusion: different segments of cervical and thoracic vertebrae. The anterior pedicle screw implantation parameters are different. Theoretically, C6C7 can be completed through the lower anterior cervical approach, and a few T1 anterior pedicle screws can be inserted, while most T1. Due to the limitation of the anterior osseous structure, T2 could not complete the anterior screw through the anterior approach of the lower cervical spine.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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