成人中上胸椎椎弓根钉进钉点与后柱骨性标志的定位关系和变化规律的影像学测量

发布时间：2018-02-16 11:41

本文关键词： 中上胸椎椎弓根螺钉内固定术进钉点三维重建 X线计算机体层摄影术骨性标志置钉准确性　出处：《第二军医大学学报》2017年07期 　论文类型：期刊论文

【摘要】：目的通过三维重建CT图像测量参数探讨成人中上胸椎椎弓根钉进钉点(PSEP)与后柱骨性标志的定位关系和变化规律。方法选取排除了畸形的30例成人中上胸椎CT图像进行三维重建,观察横突椎板凹、横突上嵴和椎板外缘等后柱骨性标志的解剖特征。在重建后的T1~T10特定CT图像上测定以下参数:(1)基础参数,即PSEP至中线的距离(PMD)、横突椎板凹至中线距离(CMD)和半椎板宽度(HLW);(2)目标参数,即点凹距离(PCD)、进钉点定位比(EPLR)和点嵴距离(PRD)。比较所有参数两侧测量值的差异和基础参数间测量值的差异,总结从T1到T10目标参数测量值的变化规律。结果中上胸椎横突椎板凹、横突上嵴和椎板外缘具有解剖标志明显、恒定且少有增生的特征。T1~T10左右两侧PMD分别为(14.14±2.63)mm和(14.59±2.58)mm,CMD分别为(10.45±2.12)mm和(10.51±2.02)mm,HLW分别为(16.30±1.48)mm和(16.39±1.61)mm,PCD分别为(4.56±1.03)mm和(4.47±0.94)mm,EPLR分别为0.35±0.26和0.33±0.30,PRD分别为(-1.62±1.90)mm和(-1.63±1.44)mm。所有参数两侧测量值差异均无统计学意义(P0.05)。除T2中PMD和HLW相比差异无统计学意义(P0.05),其余节段基础参数间测量值差异均有统计学意义(P0.01)。从T1到T10,PCD呈现先减小再增大的趋势,T1、T2、T9、T10处PCD均高于T3~T8处(P0.05);EPLR呈现先增大再减小的趋势,T1~T3处EPLR与其下方任一节段相比差异均有统计学意义(P0.01),T4~T6、T10处均低于T7~T9处(P0.01);PRD呈现先增大再减小的趋势,T1~T3处PRD与其下方任一节段相比差异均有统计学意义(P0.01),T4~T6处均低于T7~T10处(P0.01)。结论中上胸椎PSEP与横突椎板凹、横突上嵴和椎板外缘等后柱骨性标志存在相对恒定的定位关系和变化规律,可作为一种新的临床上选择进钉点的方法。
[Abstract]:Objective to study the relationship between PSEP and posterior column bony mark by measuring parameters of 3D reconstruction CT image. Methods Thirty adult patients with middle and upper thoracic vertebrae were selected for 3D reconstruction. To observe the anatomical characteristics of posterior column bone markers, such as fovea of transverse process, supratransverse ridge of transverse process and outer edge of lamina of vertebral lamina. The following basic parameters were measured on specific CT images of T _ (1) T _ (10) after reconstruction. That is, the distance between PSEP and midline, the distance from transverse process to midline, and the width of half lamina. That is, point concave distance, point location ratio (EPLR) and point crest distance (PRD). The differences between the measured values on both sides of all parameters and between basic parameters are compared, and the variation of the measured values from T1 to T10 target parameters is summarized. The supratransverse crest and the outer edge of the lamina had obvious anatomic markers. The PMD values of the two sides of T10 were 14.14 卤2.63mm and 14.59 卤2.58mm, respectively, which were 10.45 卤2.12mm and 10.51 卤2.02mm, respectively, which were 16.30 卤1.48mm and 16.39 卤1.61mm, respectively. There was no significant difference between the two sides of the parameters, the EPLR was 0.35 卤0.26 and 0.33 卤0.30PRD was -1.62 卤1.90mm and -1.63 卤1.44mm. respectively. Except that there was no significant difference between PMD and HLW in T2 (P 0.05), there were significant differences in the measured values among the other basic parameters. From T1 to T10, PCD decreased first and then increased. The PCD at T1 / T2T2T9 / T10 was higher than that at T3T8 (P0.05). There was a significant difference between EPLR at T _ 1T _ 3 and any segment below it. The EPLR at T _ (0.01) T _ (4) T _ (6) T _ (10) was lower than that at T _ (7) T _ (9). The PRD at T _ (1) T _ (3) increased first and then decreased (P _ (0.01) T _ 3). There were significant differences between PRD at T _ (1) and T _ (4) T _ (6) under T _ (1) and T _ (4) and T _ (4) T _ (6) of T _ (1) T _ 3. Conclusion the PSEP of middle and upper thoracic vertebrae and the laminar fovea of transverse process are lower than that of T7 and T10. The postcolumn bone markers such as the supratransverse crest and the outer edge of the lamina have a relatively constant localization relationship and change rule, which can be used as a new clinical method to select the point of entry into the nail.
【作者单位】：南华大学附属南华医院脊柱外科;南华大学附属南华医院放射科;中南大学湘雅三医院骨科;
【基金】：衡阳市科学技术发展计划(2016KJ45)~~
【分类号】：R687.3

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