下颈椎椎弓根螺钉钉道（Abumi法）X线评估的准确性

发布时间：2018-06-16 22:09

本文选题：X线 + 下颈椎　；参考：《山东大学》2013年硕士论文

【摘要】：目的：通过回顾性研究探讨在特定判定标准下正、斜位X线位片评估下颈椎椎弓根螺钉钉道(Abumi法)的准确性及可行性。方法：本研究回顾性地收集了2009年至2012年在我院诊为颈椎疾病(其中颈椎退行性疾病5例,颈椎外伤3例,颈椎肿瘤2例),行下颈椎椎弓根螺钉内固定术并同时具有完善X线、CT扫描及相关重建等相关影像学检查资料的10例病例,其中经Abumi法置入下颈椎椎弓根螺钉44枚,根据文献提供的下颈椎解剖及影像学测量参数,将下颈椎按内倾角度不同分为3组：A组C3-5、B组C6、C组C7(其中A组22枚螺钉,B组12枚螺钉,C组10枚螺钉)。所有患者术后均摄取颈椎正位及双侧45度斜位X线片共3张,并行CT连续平扫+矢状面+冠状面+三维重建(均为骨窗)。X线片判断包括通过观察正位片上螺钉尖端与钩椎关节内外侧边界的关系判断螺钉是否穿破椎弓根内、外侧壁；通过观察对侧45度斜位片上椎弓根的较长径线判断螺钉是否穿破椎弓根上下壁。CT判断包括通过观察轴位的连续断面,判断螺钉全长路径中是否穿破椎弓根内侧、外侧壁；通过观察矢状位重建的连续断面,判断螺钉全长路径中是否穿破椎弓根上下壁。以CT判断结果为标准,分别统计X线判断各组螺钉与椎弓根各侧壁关系的相对敏感性、特异性及准确性,并比较此方法判断椎弓根各侧壁关系的相对准确性在各组间的差异。结果：本方法判断各组螺钉与椎弓根各壁关系结果与CT扫描及相关重建观察结果相比的相对敏感性及特异性较高(内侧壁敏感性：A组100%、B组100%、C组缺少阳性数据,内侧壁特异性：A组95.5%、B组100%、C组100%,外侧壁敏感性：A组100%、B组88.9%、C组100%,外侧壁特异性：A组100%、B组100%、C组75.0%,上壁敏感性：A组100%、B组100%、C组缺少阳性数据,上壁特异性：A组90.9%、B组100%、C组100%,下壁敏感性：A组缺少阳性数据、B组缺少阳性数据、C组100%,下壁特异性：A组100%、B组100%、C组66.7%)；相对准确性为内侧壁A组95.5%、B组100%、C组100%,外侧壁A组100%、B组91.7%、C组90.0%,上壁A组95.5%、B组100%、C组100%,下壁A组100%、B组100%、C组80.0%；A、C组判断螺钉与下壁间关系的相对准确性存在统计学差异(P＜0.05),其他各侧壁的相对准确性在各组间无统计学差异(P＞0.05)。结论：本研究提出的经特定判断标准使用正、斜位X线片评价下颈椎椎弓根螺钉钉道的方法,以CT判断结果为标准,其相对敏感性、特异性及准确性较高,且在下颈椎的不同节段均适用,可基本满足临床应用要求,可基本取代CT扫描及相关重建的钉道判断方法,不失为临床工作中一种低放射暴露、经济、快速、准确的钉道判断方法。
[Abstract]:Objective: to evaluate the accuracy and feasibility of X-ray radiography in evaluating the pedicle screw of lower cervical spine (Abumi method) according to the specific criteria. Methods: from 2009 to 2012, we retrospectively collected 5 cases of cervical degenerative diseases, 3 cases of cervical trauma, and 3 cases of cervical degenerative diseases in our hospital from 2009 to 2012. Two cases of cervical spine tumor were treated with internal fixation of pedicle screw of lower cervical vertebrae and 10 cases with complete X-ray CT scan and related reconstruction. 44 screws of lower cervical pedicle were inserted by Abumi method. According to the anatomical and imaging parameters of the lower cervical vertebrae, the lower cervical vertebrae were divided into 3 groups according to the angle of introversion. The lower cervical vertebrae were divided into 3 groups according to the angle of introversion. All the patients received 3 X-ray films of the cervical vertebrae in positive position and 45 degree oblique position after operation. Three dimensional reconstruction of the coronal plane of the sagittal plane (all bone window. X ray images) with CT scan included observing the relationship between the tip of the screw on the positive film and the inner and outer boundary of the hook joint to determine whether the screw penetrated the medial and lateral wall of the pedicle. By observing the longer diameter of the pedicle on the contralateral 45 degree oblique film to determine whether the screw pierced the upper and lower wall of the pedicle, including observing the continuous cross-section of the axial position, it was determined whether the medial and lateral wall of the pedicle was broken in the full length path of the screw. A continuous section of sagittal reconstruction was observed to determine whether the pedicle wall was broken through the full length of the screw. The relative sensitivity, specificity and accuracy of the relationship between the screw and the lateral wall of the pedicle in each group were statistically analyzed according to the results of CT, and the differences of the relative accuracy of the method in judging the relationship between the lateral wall of the pedicle and the lateral wall of the pedicle were compared. Results: the relative sensitivity and specificity of the relationship between screw and pedicle wall in each group were higher than those of CT scan and related reconstruction. (the sensitivity of medial wall was less in group A than in group B and group C, respectively). The sensitivity of the lateral wall to the lateral wall of group A was 95.5% and that of group B was 100. The sensitivity of the lateral wall was 10: 1. The sensitivity of the lateral wall was 100%. The sensitivity of the lateral wall was 88.9% in group B. The specificity of the lateral wall was 75.0% in group B and 75.0% in group B. The sensitivity of the upper wall was not positive in group A and group B, and there was no positive data in group B. The sensitivity of the inferior wall to the lower wall in group A was lack of positive data, in group B was lack of positive data. In group B, the specific wall of group A was 90.9% and that in group B was 66.7. The relative accuracy was as follows: the medial wall of the lateral wall of group A was 95.5 and that of group B was 100; the lateral wall of group A was 91.7; the upper wall of group A was 90.0; the upper wall of group A was 95.5 and that of group B was 100; the inferior wall of group A was 100 and that of group B was 80.0. There was significant difference in the relative accuracy of the relationship between the screw and the inferior wall in group A (P < 0.05), but there was no significant difference in the relative accuracy of the other lateral walls among the groups (P > 0.05). Conclusion: the method of using positive and oblique radiographs to evaluate the nail passage of pedicle screw of lower cervical vertebrae was put forward in this study. According to the result of CT, the relative sensitivity, specificity and accuracy of the method were high. It can be used in different segments of the lower cervical vertebrae and can basically meet the requirements of clinical application. It can basically replace the method of judging the nail path of CT scan and related reconstruction. It is a kind of low radiation exposure, economical and rapid in clinical work. Accurate judgment method of nail track.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R681.5;R816.8

【共引文献】