下颈椎椎弓根钉进钉点与关节突间侧凹的三维定位关系

发布时间：2018-02-23 04:02

本文关键词： 颈椎骨钉内固定器组织工程骨科植入物脊柱植入物下颈椎椎弓根螺钉内固定进钉点三维重建 CT 测量关节突置钉准确性　出处：《中国组织工程研究》2017年11期 　论文类型：期刊论文

【摘要】：背景:现有的下颈椎椎弓根钉固定技术均以关节突和侧块为参考标志,由于术者主观判断的差异,加之关节突增生的影响,进钉点的选择常有一定误差,易发生椎动脉或颈髓损伤等严重并发症,限制了该技术临床推广。目前临床上选择一个恒定的下颈椎椎弓根钉进钉点标志显得尤为重要。目的:通过三维重建CT图像测量明确下颈椎椎弓根钉进钉点与"关节突间侧凹"的定位关系。方法:对排除颈椎畸形的30例患者颈椎行三维重建CT扫描,观察"关节突间侧凹"的出现率和形态特征。在重建后的C_3-C_7特定CT图像上测定以下参数:(1)进钉点至侧块外缘的距离:经双侧椎弓根轴线横断面图像上椎弓根轴线在后柱表面投影点与侧块最外缘的距离;(2)进钉点至"关节突间侧凹"的距离:经单侧椎弓根轴线斜矢状面图像上椎弓根轴线在后柱表面投影点与"关节突间侧凹"的距离。统计每组参数的平均值和标准差,并比较各节段统计数据的差异。结果与结论:(1)下颈椎"关节突间侧凹"明显,出现率为100%,解剖标志恒定且少有增生;(2)利用三维重建CT技术,可以成功获取C_3-C_7经双侧椎弓根轴线横断面和经单侧椎弓根轴线斜矢状面的图像;(3)在经双侧椎弓根轴线横断面图像上,C_3-C_7左右两侧进钉点至侧块外缘的距离分别为(4.1±0.9)mm和(4.3±0.9)mm,差异无显著性意义(P=0.609)。除了C_3与C_7、C_4与C_7,各节段同侧测量值的差异均无显著性意义(P0.05);(4)在经单侧椎弓根轴线斜矢状面的图像上,C3-C7左右两侧进钉点至"关节突间侧凹"的距离距离分别为(-0.3±1.7)mm和(-0.3±1.6)mm,差异无显著性意义(P=0.916)。除了C3与C4,各节段同侧测量值的差异均有显著性意义(P0.05);(5)以上结果提示,下颈椎椎弓根钉进钉点与"关节突间侧凹"在横断面上存在相对恒定的定位关系,而在矢状面上变异较大。
[Abstract]:Background: the existing techniques of pedicle screw fixation of lower cervical vertebrae take the articular process and lateral mass as reference marks. Due to the difference of subjective judgment of the operator and the influence of the proliferation of the articular process, the selection of the point of entry nail is often wrong. Serious complications such as vertebral artery or cervical spinal cord injury are likely to occur. At present, it is very important to select a constant nail point marker for the lower cervical pedicle screw. Objective: to determine the screw point of the lower cervical pedicle by three-dimensional reconstruction CT image measurement. Methods: thirty patients with cervical vertebrae who were excluded from cervical deformities underwent 3D reconstruction CT scanning. To observe the occurrence rate and morphological features of "interarticular facet fovea". The following parameters were measured on the reconstructed C3-CSP 7 specific CT images: the distance between the insertion point and the outer edge of the lateral mass: the axial line of the pedicle through the bilateral pedicle axial line of the vertebrae on the cross-sectional image of the axial line of the pedicle of the vertebral arch. Distance from the projection point on the surface of the posterior column to the outermost edge of the lateral mass to the "lateral concave of the articular process": transpedicular axial line oblique sagittal image of the pedicle axis on the surface of the posterior column and "interarticular facet lateral concave" on the surface of the posterior column. "to count the average and standard deviations of each set of parameters, Results and conclusion the "interarticular facet fovea" of the lower cervical vertebrae was obvious, the occurrence rate was 100, the anatomic mark was constant and there were few proliferative lesions. Images of C _ 3-C _ 7 transpedicular axis cross section and unilateral pedicle axis oblique sagittal plane can be obtained successfully) on bilateral pedicle axis cross-sectional images, the distance between C _ 3-C _ She _ 7 and lateral mass is 4.1 卤0.9mm, respectively. There was no significant difference between C _ 3-C _ 7 and C _ 7C _ 4 and C _ 7. There was no significant difference in the ipsilateral measurements of each segment between C _ 3-C _ 7 and C _ 7C _ 7. There was no significant difference in the ipsilateral measurements of each segment (P < 0.05). On the images of oblique sagittal plane across the axis of unilateral pedicle, there was no significant difference between C _ 3-C _ 7 and C _ 3-C _ 7 to "interarticular fovea". "the distance of distance was -0.3 卤1.7 mm and -0.3 卤1.6 mm, respectively, and there was no significant difference between them. Except for C3 and C4, there were significant differences in ipsilateral measurements of each segment. There was a relatively constant orientation relationship between the nail point of the pedicle of the lower cervical vertebrae and the "interarticular lateral fovea" on the cross section, but there was a great variation on the sagittal plane.
【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;
【分类号】：R687.3

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