[1]王亚楠,李青松,谢梦琦,等.椎弓根螺钉内固定术中应用锥束CT扫描评估椎弓根螺钉位置及椎弓根破坏情况的准确性临床研究[J].中医正骨,2017,29(10):25-29.
　WANG Yanan,LI Qingsong,XIE Mengqi,et al.Clinical study on accuracy of cone beam computed tomography scanning in evaluating location of pedicle screws and severity of damage of pedicle of vertebral arch in surgery of pedicle screw internal fixation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):25-29.
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椎弓根螺钉内固定术中应用锥束CT扫描评估椎弓根螺钉位置及椎弓根破坏情况的准确性临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年10期
页码:
25-29
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Clinical study on accuracy of cone beam computed tomography scanning in evaluating location of pedicle screws and severity of damage of pedicle of vertebral arch in surgery of pedicle screw internal fixation
作者:
王亚楠; 李青松; 谢梦琦; 郭明明; 孟令志; 王琪
中国人民解放军沈阳军区总医院,辽宁 沈阳 110801
Author(s):
WANG Yanan; LI Qingsong; XIE Mengqi; GUO Mingming; MENG Lingzhi; WANG Qi
General Hospital of Shenyang Military District of PLA,Shenyang 110801,Liaoning,China
关键词:
体层摄影术; X线计算机;  锥束CT;  椎弓根螺钉
Keywords:
Key words tomography; X-ray computed;  cone beam computed tomography;  pedicle screw
摘要:
目的:探讨椎弓根螺钉内固定术中应用锥束CT扫描评估椎弓根螺钉位置及椎弓根破坏情况的准确性。方法:2015年10月至2017年6月收治43例因脊柱病变需接受椎弓根螺钉内固定手术的患者,腰椎退行性疾病21例、胸腰椎骨折9例、胸腰椎肿瘤11例、脊柱畸形2例,分别经后路进行椎间融合、骨折复位内固定、肿瘤切除内固定和脊柱矫形手术。术中置入椎弓根螺钉后用Artis Zeego系统行锥束CT扫描,了解螺钉位置和椎弓根破坏情况,必要时及时进行调整。术后1周内所有患者均采用CT进行病变部位扫描,了解螺钉位置和椎弓根破坏情况。分别根据术中锥束CT扫描图像和术后CT扫描图像采用Gertzbein分级系统评估螺钉位置和椎弓根破坏情况。结果:43例患者均顺利完成手术,手术时间(224.2±47.1)min,术中出血(482.6±471.6)mL。43例患者共置入262枚椎弓根螺钉,胸椎置钉104枚、腰椎置钉142枚、骶骨(S1节段)置钉16枚。无1例患者因椎弓根螺钉误置行二次手术调整钉位,未发生椎弓根螺钉置入导致的神经损伤。置入的262枚螺钉中,仅10枚螺钉根据术中锥束CT图像评估的分级结果与根据术后CT图像评估的分级结果不一致。根据术中锥束CT图像评估的分级结果与根据术后CT图像评估的分级结果具有非常好的一致性(Kappa=0.804,P=0.000)。结论:椎弓根螺钉内固定手术中,应用锥束CT扫描评估螺钉位置和椎弓根破坏情况,准确性较高。
Abstract:
ABSTRACT Objective:To explore the accuracy of cone beam computed tomography(CT)scanning in evaluating the location of pedicle screws and the severity of damage of pedicle of vertebral arch in the surgery of pedicle screw internal fixation.Methods:Forty-three patients were recruited from October 2015 to June 2017 and they needed pedicle screw internal fixation for treatment of spinal lesions,including lumbar degenerative disease(21),thoracolumbar vertebral fracture(9),thoracolumbar tumors(11)and spinal deformity(2).Intervertebral fusion,fracture reduction and internal fixation,tumor removal and internal fixation and spinal orthopedic surgery were performed on patients respectively through posterior approach.Cone beam CT scanning was performed on all patients using Artis Zeego system after pedicle screws were inserted into the pedicle of vertebral arch to know about the location of pedicle screws and the severity of damage of pedicle of vertebral arch.The location of pedicle screws were adjusted in time if necessary.The diseased region was scanned in all patients by using CT within one week after surgery to know about the location of pedicle screws and the severity of damage of pedicle of vertebral arch.The location of pedicle screws and the severity of damage of pedicle of vertebral arch were evaluated by using Gertzbein rating system according to the intraoperative cone beam CT scanning images and postoperative CT scanning images respectively.Results:The surgeries were finished successfully in all patients,and the operative time and intraoperative blood loss were 224.2+/-47.1 min and 482.6+/-471.6 ml respectively.A total of 262 pedicle screws were inserted into pedicles of vertebral arch in 43 patients,including thoracic pedicle screws(104),lumbar pedicle screws(142)and sacral pedicle screws at S1 segment(16).No patient underwent reoperation for pedicle screw location correction,and no nerve injury caused by pedicle screw insertion was found.The intraoperative cone beam CT images were inconsistent with the postoperative CT images in the rating results for only 10 of 262 screws.The rating results showed very good consistency between intraoperative cone beam CT images and postoperative CT image(Kappa=0.804,P=0.000).Conclusion:The location of pedicle screws and theseverity of damage of pedicle of vertebral arch can be evaluated accurately using cone beam CT scanning in the surgery of pedicle screw internal fixation.

参考文献/References:

[1] JUTTE PC,CASTELEIN RM.Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations[J].Eur Spine J,2002,11(6):594-598.
[2] LI G,LV G,PASSIAS P,et al.Complications associated with thoracic pedicle screws in spinal deformity[J].Eur Spine J,2010,19(9):1576-1584.
[3] RAO G,BRODKE DS,RONDINA M,et al.Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement[J].J Neurosurg,2002,97(2 suppl):223-226.
[4] GERTZBEIN SD,ROBBINS SE.Accuracy of pedicular screw placement in vivo[J].Spine(Phila Pa 1976),1990,15(1):11-14.
[5] AMIOT LP,LANG K,PUTZIER M,et al.Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic,lumbar, and sacral spine[J].Spine(Phila Pa 1976),2000,25(5):606-614.
[6] PARKER SL,MCGIRT MJ,FARBER SH,et al.Accuracy of free-hand pedicle screws in the thoracic and lumbar spine:analysis of 6816 consecutive screws[J].Neurosurgery,2011,68(1):170-178.
[7] DONOHUE ML,MOQUIN RR,SINGLA A,et al.Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?[J].J Neurosurg Spine,2014,20(5):492-496.
[8] 杨波,方世兵,尹飚,等.三维重建腰椎椎弓根螺钉置入的精确性[J].中国组织工程研究,2013,17(13):2333-2338.
[9] 闫煌,刘臻,伍伟飞,等.腰椎脊柱侧凸矫正中电钻驱动与克氏针加叩击法技术置钉精确性与安全性的比较研究[J].中国骨与关节杂志,2016,5(6):454-458.
[10] 周文钰,陈扬,李振宇.三维CT导航在腰椎再次手术及翻修术中椎弓根螺钉置入的应用研究(附13例报告)[J].中国骨与关节损伤杂志,2010,25(3):199-201.
[11] AVILA MJ,BAAJ AA.Freehand Thoracic Pedicle Screw Placement:Review of Existing Strategies and a Step-by-Step Guide Using Uniform Landmarks for All Levels[J].Cureus,2016,8(2):e501.
[12] LEHMAN RA,POTTER BK,KUKLO TR,et al.Probing for thoracic pedicle screw tract violation(s)-Is it valid?[J].J Spinal Disord Tech,2004,17(4):277-283.
[13] BELMONT PJ,KLEMME WR,DHAWAN A,et al.In vivo accuracy of thoracic pedicle screws[J].Spine(Phila Pa 1976),2001,26(21):2340-2346.
[14] KAMINSKI L,CORDEMANS V,CARTIAUX O,et al.Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique:a preliminary study[J].Eur Spine J,2017.doi:10.1007/s00586-017-4968-z.
[15] GEBHARD FT,KRAUS MD,SCHNEIDER EA,et al.Does computer-assisted spine surgery reduce intraoperative radiation doses?[J].Spine(Phila Pa 1976),2006,31(17):2024-2027.
[16] CORDEMANS V,KAMINSKI L,BANSE X,et al.Accuracy of a new intraoperative cone beam CT imaging technique(Artis zeegoⅡ)compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection[J].Eur Spine J,2017.doi:10.1007/s00586-017-5139-y.
[17] BROOKS D,ESKANDER M,BALSIS S,et al.Imaging assessment of lumbar pedicle screw placement:sensitivity and specificity of plain radiographs and computer axial tomography[J].Spine(Phila Pa 1976),2007,32(13):1450-1453.
[18] LEARCH TJ,MASSIE JB,PATHRIA MN,et al.Assessment of pedicle screw placement utilizing conventional radiography and computed tomography:A proposed systematic approach to improve accuracy of interpretation[J].Spine(Phila Pa 1976),2004,29(7):767-773.
[19] YOO JU,GHANAYEM A,PETERSILGE C,et al.Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine[J].Spine(Phila Pa 1976),1997,22(22):2668-2671.

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备注/Memo

备注/Memo:
基金项目:中国博士后科学基金面上项目(2015M582821); 辽宁省自然科学基金(201602794) 通讯作者:王琪 E-mail:ven15@126.com
更新日期/Last Update: 2018-03-10