| 卢照应,卢海川,邱永荣,汤凯,林晓贞.椎弓根螺钉内固定术中X线测量椎弓根螺钉横断面倾角[J].脊柱外科杂志,2016,14(3):159-164. |
椎弓根螺钉内固定术中X线测量椎弓根螺钉横断面倾角  点此下载全文 (Fulltext) |
| 卢照应 卢海川 邱永荣 汤凯 林晓贞 |
| 福建医科大学附属龙岩第一医院脊柱外科, 福建 364000 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2016.03.007 |
| 摘要点击次数: 809 |
| 全文下载次数: 397 |
| 摘要： |
| 目的 探讨术中利用C形臂X线机测量椎弓根螺钉横断面倾角(STA)的临床应用价值。方法 选取胸腰椎椎弓根螺钉内固定术患者43例,术中利用C形臂X线机正位像测量椎体旋转度(VRD)、椎弓根螺钉空间旋转度(SSR),并计算STA(STA=SSR-VRD);术后利用CT横断面图像测量椎弓根螺钉实际STA。选取同一术者手术的20例患者的20枚椎弓根螺钉(每例1枚),分别在初始位(目标显像在图像中央)、球管高移位、球管低移位、球管左移位、球管右移位、球管头移位、球管尾移位、球管头倾斜照位及球管尾倾斜位照位9个不同透视机投照位置下测量VRD、SSR并计算STA,分析测量者测量结果的内部差异性。另选取20例患者的20枚椎弓根螺钉,由3名不同医生依上述方法测量VRD、SSR并计算STA,分析测量者间测量结果的差异性。结果 椎弓根螺钉CT测量STA范围为-4.5°~27.3°(内倾为正角度),术中X线机测量值与术后CT测量值差距为-2.7°~3.2°,2组间差异无统计学意义(P>0.05)。测量者测量结果的内部差异性分析结果显示,球管左移或右移时VRD、SSR及STA测量值与初始位置测量值差异存在统计学意义(P<0.05),其他不同位置测量值与初始位置测量值差异无统计学意义(P>0.05)。测量者间差异性分析显示,3名医生测量结果差异无统计学意义(P>0.05)。结论 术中利用C形臂X线机能较准确地评估STA。当术者遇到置钉困难时,可利用该方法测量STA并指导置钉,提高术者置钉信心及手术安全性。 |
| 关键词：胸椎 腰椎 骨钉 骨折固定术,内 生物力学 |
| Roentgenographic measurement of screw transverse angle in thoracolumbar pedicle screw fixation Fulltext |
| LU Zhao-ying LU Hai-chuan QIU Yong-rong TANG Kai LIN Xiao-zhen |
| Department of Spine Surgery, Longyan NO. 1 Hospital, Fujian Medical University, Longyan 364000, Fujian, China |
| Fund Project: |
| Abstract: |
| Objective To explore the clinical value for intraoperative measurement of the screw transverse angle(STA) using C-arm fluoroscopy. Methods Forty-three patients who had accepted thoracolumbar pedicle screw fixations were included in the study. Vertebral rotational degree(VRD) and screw's space rotation(SSR) were measured with the different projections using C-arm fluoroscopy;STA was calculated, which was equal to the difference between SSR and VRD. The actual STA on the CT image was measured after surgery. Twenty pedicle screws were done by one surgeon to analyze the intra-observer difference. VRD and SSR were measured at 9 different positions of radioactive source and STA was calculated then. These positions included initial position(target imaging in the center of screen), the tube down, tube up, tube left, tube right, tube panned to the head, tube panned to the tail, tube tilted to the head, and tube tilted to the tail. Twenty pedicle screws were done by 3 surgeons to analyze the inter-observer difference. They independently completed the measurement of VRD and SSR in these cases, and then calculated STA. Results The STAs of 43 cases were from -4.5° to 27.3° measured by CT after operation. The differences between the STAs by CT after operation and by X-ray intra-operation were from -2.7° to 3.2°. The paired t-test showed no statistical difference between the 2 STA values(P>0.05). The result in the intra-observer difference experiment showed statistical difference between values of VRD, SSR and STA when there was a left or right shift of the tube positions and those of the initial position(P<0.05), but there was no statistical difference between other positions and the initial position(P>0.05). The inter-observer difference analysis showed no statistical difference between the results measured independently by 3 surgeons (P>0.05). Conclusion When surgeons suffer some difficulty of pedicle screw fixation, this technique can be used to assess the STA and enhance the surgeon's confidence and surgical safety. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Bone nails Fracture fixation, internal Biomechanics |
|
|
HTML
查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
|
|
