经皮椎弓根置钉的相关研究及经皮椎弓根置钉定位装置的研制与临床应用

发布时间：2018-04-10 07:24

本文选题：脊柱　切入点：经皮椎弓根置钉　出处：《南昌大学》2015年硕士论文

【摘要】：第一部分:下胸椎与腰椎节段椎弓根置钉相关影像学数据的测量及其临床意义目的利用下胸椎与腰椎椎弓根的的X片及CT片测量相关影像数据并进行统计分析,为经皮椎弓根置钉和设计经皮椎弓根置钉定位装置提供参考依据。方法收集20例胸腰椎标准正侧位X片(男性10例、女性10例);收集10例下胸椎与腰椎的CT影像数据。选择无明显骨缺损及发育异常的椎体影像为标本,节段为T9-L5椎体。在X片上测量T9-L5椎弓根进针点的距离及两髂骨最高点连线与各椎弓根进针点的距离。在PACS系统中,CT操作界面下进行T9-L5的椎弓根的长度与椎弓根通道的长度、椎弓根的外倾角与上倾角、椎弓根峡部的高度与宽度的数据测量。结果在X片上显示T9-L5椎弓根影的最外侧缘距离逐渐增大,T9-L1增大缓慢,L2-L5增大明显,男性最大值为66.81mm,女性为63.21mm。男女间各椎体数据对比显示,男性进针点宽度明显大于女性,两组之间差异有统计学意义(P0.05)。左右髂骨最高点连线到进针点的距离,男性最远为275.32mm,女性为267.49mm,男女间各椎体数据对比,两组之间差异有统计学意义(P0.05),同时髂骨最高点连线均大致平L4与L5间隙。CT测量显示椎弓根的长度显示:L5节段最短,平均为14.5mm;L2节段最长,平均为23.3mm,左右椎弓根对比,无显著差异(P0.05);椎弓根通道在T11节段最短,平均为43.3mm;L2节段最长,平均为52.4mm,左右两侧对比无显著差异(PO.05)。T9-T12的椎弓根外倾角呈下降趋势,从T12至L5呈上升趋势,T12最小,平均为-1.4°;L5最大,平均为24.9°,左右两侧对比,无显著差异性(P0.05)。然而T9-L5椎弓根的上倾角呈减小趋势,T9为最大值,平均为12.9°,L5达最小值,部分呈现负角度,平均为-1.1°,左右两侧的椎弓根角度值对比,无显著差异性(P0.05)。T9-T12椎弓根峡部高度和宽度依次增大,L1-L2节段稍下降,L2-L5呈递增趋势,L5达最大值,左右对比无显著差异(P0.05),椎弓根峡部的高度较宽度大。结论下胸椎与腰椎椎弓根的结构虽存在差异,但存在一定规律,准确了解椎弓根形态结构与影像特点,为椎弓根螺钉置入装置设计与经皮椎弓根螺钉置入提供指导作用,提高手术安全性与准确性。第二部分:经皮椎弓根置钉定位装置的设计及研制目的研制经皮椎弓根置钉定位装置,为经皮椎弓根螺钉置入提供辅助手段。方法根据椎弓根在X片与CT上的影像特点及其测量数据,利用该定位装置确定椎体与螺钉的空间位置,结合进针点和上倾角和外倾角设计经皮椎弓根置钉定位装置。结果经皮椎弓根置钉定位装置制作简易,操作方便。结论经皮椎弓根定位装置可应用于临床以便观察其对经皮椎弓根置钉术的应用效果。第三部分:经皮椎弓根置钉定位装置在胸腰椎经皮椎弓根置钉中的临床应用目的探讨经皮椎弓根置钉定位装置在经皮椎弓根置钉术中的临床应用效果。方法收集2014年01月-2014年12月使用经皮椎弓根定位装置定位和克氏针定位的经皮椎弓根螺钉置入术的病例共30例,均为椎体压缩性骨折的患者,根据不同定位方法进行分组,15例使用经皮椎弓根定位装置定位的为实验组,另外15例应用克氏针进行定位的为对照组,椎弓根螺钉置入的数量均为60枚。对比两组中使用C臂机的次数、手术时间、螺钉穿破椎弓根数量,进行统计学分析。结果在两组患者中,使用C臂机的次数、手术时间、螺钉穿破椎弓根数量,实验组为18.02±2.19次、103.56±16.12min?、2枚及对照组为27.35±3.38次、?125.26±15.92min?、4枚。两组间螺钉穿破椎弓根的数量?对比,无统计学差异(P0.05);两组间C臂机使用次数、手术时间对比,差异存在统计学意义(P0.05)。结论在经皮椎弓根螺钉置入术,经皮椎弓根定位装置的应用虽不能降低手术并发症的发生率,但可以减少术中C臂机的使用次数及缩短手术时间,?是一种安全有效的定位方法。
[Abstract]:The first part: the lower thoracic and lumbar pedicle screw imaging data measurement and clinical significance of lower thoracic and lumbar pedicle by the measurement of X film and CT film related image data and statistical analysis for percutaneous pedicle screw and percutaneous pedicle screw positioning device provides the reference method. The collection of 20 cases of thoracolumbar standard anteroposterior and lateral X (10 cases, 10 males); collect CT image data of 10 cases of thoracic and lumbar vertebrae. No obvious bone defect and vertebral body image abnormalities were segments of T9-L5 vertebral body. Measuring the needle points on the X film on the T9-L5 pedicle the distance and the two line and the highest point of the iliac pedicle entry point distance. In the PACS system, the length of the pedicle T9-L5 CT interface and the pedicle channel length, angle and angle of pedicle, pedicle isthmus high Data measurement and width. The lateral edge distance T9-L5 pedicle shadow gradually increased display on X, T9-L1 increases slowly, L2-L5 increased obviously, the maximum value is 66.81mm male female, 63.21mm. between male and female vertebral data comparison, male needle width was significantly larger than that of female, there were significant differences between the two group between (P0.05). The highest point is connected to the left iliac needling point distance, as far as male 275.32mm, female 267.49mm, and the vertebral body data comparison, there were statistically significant differences between the two groups (P0.05), and the highest point line of ilium generally flat L4 and L5 gap.CT measurements showed that the pedicle length display L5: the shortest segment, the average is 14.5mm; the L2 segment is the longest, the average is 23.3mm, compared to no significant difference about pedicle, pedicle channel (P0.05); the shortest in the T11 segment, the average is 43.3mm; the L2 segment is the longest, the average is 52.4mm, There was no significant difference between the left and right sides of (PO.05).T9-T12 pedicle angle decreased, increased from T12 to L5 T12 minimum, average -1.4 degrees; the maximum L5, the average is 24.9 degrees, the left and right sides of comparison, no significant difference (P0.05). However, T9-L5 pedicle angle decreased. T9 is the maximum value, the average is 12.9 degrees, L5 reaches a minimum value, part of the negative angle, average -1.1 degrees, between left and right sides of the pedicle angle value, no significant difference (P0.05).T9-T12 isthmus height and width increases, the L1-L2 segment was slightly decreased, L2-L5 increased, L5 reached the maximum value, no significant difference about contrast (P0.05), the isthmus is lower than the width. Conclusion thoracic and lumbar pedicle structure although there are differences, but there are certain rules, accurate understanding of the pedicle morphology and image characteristics, design for pedicle screw insertion device Percutaneous pedicle screw placement and provide guidance, improve the operation safety and accuracy. The second part: percutaneous pedicle screw positioning device design and development objective to develop the percutaneous pedicle screw positioning device, percutaneous pedicle screw placement with aid. Methods according to the imaging features of X and CT in the pedicle and its tablets the measurement data, using the positioning device to determine the location of vertebral body and screw, with the needle point and angle and camber design of percutaneous pedicle screw positioning device. The results of percutaneous pedicle screw positioning device to create a simple, convenient operation. Conclusion percutaneous pedicle positioning device can be used in clinical to observe the application the effect of percutaneous pedicle screw surgery. The third part: percutaneous pedicle screw positioning device for percutaneous pedicle screw in the clinical application of percutaneous pedicle in thoracolumbar spine Pedicle screw positioning device in percutaneous Shiumi Ne nailing clinical effect of surgery. Methods from 2014 December 01 months -2014 years by positioning skin Shiumi Ne positioning device and positioning percutaneous Kirschner Shiumi Ne screw fixation in 30 cases, all patients with vertebral compression fractures, grouped according to different location methods 15 cases with positioning skin Shiumi Ne positioning device for the experimental group, the other 15 cases using Kirschner wire positioning for the control group, the number of Shiumi Ne screw placement was 60. Compared the number of using the C arm machine in the two groups of operation time, the number of screws worn out Shiumi Ne, results were statistically analyzed. In two patients, the number of C arm machine operation time, the number of screws worn out Shiumi Ne, experiment group is 18.02 + 2.19, 103.56 + 2 16.12min?, and the control group is 27.35 + 3.38, 125.26 + 15.92min?? 4, between the two groups. The number of the pedicle? Comparison, no statistically significant difference between the two groups (P0.05); the C arm machine number, operation time comparison, the difference was statistically significant (P0.05). Conclusion percutaneous pedicle screw implantation, application of percutaneous pedicle positioning device can reduce the incidence of complications, but can reduce the intraoperative C arm machine use times and shorten the operation time,? Is a safe and effective method.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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