脊柱侧凸的数字化三维重建及临床应用

摘要

目的 评价三维重建在脊柱侧凸诊断和治疗中的价值.方法 确诊为不同类型的脊柱侧凸患者36例,36例患者分为2组:三维重建组16例,对照组20例.三维重建组术前进行单椎体椎弓根平面扫描重建,评价椎弓根的旋转角度、适宜进钉点、进钉长度、矢状位倾斜角度.术中均采用徒手椎弓根穿刺技术记录术中一次性椎弓根穿刺成功率.术后根据CT检查评估椎弓根螺钉植入位置,穿孔螺钉测量与理想进钉角度差.X线评价术后Cobb角和矫正率.结果 Cobb角:三维重建组为(36.70±16.6)°,对照组为(37.30±13.2)°,矫正率分别为71.3%和65.1%.椎弓根一次穿刺成功率:三维重建组为96.3%,对照组为79.5%,穿孔率:三维重建组为3.3%,对照组为11.5%.结论 三维重建能够更好地显示脊柱侧凸的情况,有助于判断脊柱侧凸的类型和累及节段,为临床制定个性化的手术方案提供依据.%Objectives To investigate the valuation of digital three-dimensional reconstruction of spine in the management of complicated spinal kyphoscliosis deformity.Method Thirty-six cases with different types of scoliosis were involved in this study,using Siemens somatom definition DSCT scanner.All data obtained were reconstructed to create the best image.Cobb's angle and sagittal angle of pedicl were measured.of the vertebral pedicle,the rotate on angles of vertebra,Examination entrance point of pedicle screw,and the distance of pedicle screw,Three-dimensional digital reconstruction used to instruct operative procedures.Results The postoperative Cobb's angle was (36.70±16.6)°in MPR-CT group.and (37.30±13.2)° in control group.The correction rate was 71.3％and 65.1％respectively.The one time successful penetration rate of MPR-CT group was 96.3％ and 79.5％ in MPR-CT group and control group.The perforation rate was 3.3％ and 11.5％ in MPR-CT group and in control group.Using the digital technique,we can analyze abnormal spines from any angles or any orientations,as well measure data,design operation or imitate the process of implanting the internal fixation devices.Conclusion Pathological information can be observed accurately and directly by digital spine,by which preoperative plan and operation can be conducted.