多层螺旋CT腰椎三维成像在椎弓根螺钉置入术中的应用

摘要

Purpose To evaluate the role of multi-slice spiral computed tomography (MSCT) VR imaging in lumbar pedicle screw implantation. Materials and Methods A total of 63 cases receiving pedicle screw implantation from Luzhou Medical College Hospital by the same surgeon were selected into the study.The patients were grouped into A or B groups according to whether they have preoperative lumbar 3D imaging using MSCT. Group Apatients underwent preoperative imaging of the lumbar spine. The imaging data were utilized to determine the direction and depth of pedicle screw placement, as well as screw length and diameter. Group B patients didn’t undergo CT exam.These two groups of patients were compared evaluated after surgery to compare the surgery outcome. Results In group A of 37 patients, 164 pedicle screws were implanted without postoperative neurological complications. The success rate was 97％. In group B of 26 patients, 104 pedicle screws were implanted. After surgery there were 2 cases of cerebrospinal fluid leakage and l case of mild nerve root injury with a success rate of 73％. This difference was statistically significant (Fisher’ s exact test, P ＜ 0.05). X-ray assessment of screw position was better for group A patients (χ2 = 26.454, P ＜ 0.05). CT assessment of screw position was also significantly different for group A and group B patients (χ2 = 17.610, P ＜ 0.05). Conclusion MSCT three-dimensional imaging of lumbar spine can provide valuable information for screws implantation, which improves the surgical outcome.%目的 评估多层螺旋CT(MSCT)VR法腰椎三维成像在椎弓根螺钉置入术中的作用.资料与方法 收集泸州医学院附属医院同一医师行椎弓根螺钉置入术者63例,依据术前是否行多层螺旋CT腰椎三维成像分成A、B两组.A组(n=37)术前均行多层螺旋CT腰椎三维成像,并获得拟置入螺钉的椎弓根有关数据,依照测量数据确定椎弓根螺钉置入的方向、深度及螺钉的长度和直径.B组(n=26)术前不做腰椎三维成像,采用传统方法置入螺钉.比较两组的手术效果和螺钉置入质量的差异.结果 63例患者均顺利完成手术,A组37例患者共置入164枚椎弓根螺钉,伞部病例无硬膜损伤及神经系统并发症,疗效评定优良率为97%.B组26例患者共置入104枚椎弓根螺钉,2例发生脑脊液漏,1例神经根轻度损伤.疗效评定优良率为73%.手术效果评估A组优于B组,差异有统计学意义(P<0.05);螺钉位置评估A组亦优于B组.X线片评估A组与B组螺钉位置,两组差异有统计学意义(χ<'2>=26.454,P<0.05);CT评估A组与B组螺钉位置,两组间差异亦具有统计学意义(χ<'2>=17.610,P<0.05).结论 MSCT腰椎三维成像能为准确置入椎弓根螺钉并选择适当长度和直径的螺钉提供有利的依据,提高了椎弓根螺钉置入术的质量和手术疗效.