本文關(guān)鍵詞： 頸胸段 前路椎弓根 影像學(xué)　出處：《寧波大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究脊柱頸胸段前路椎弓根螺釘在椎體前面置入的進釘位置和進釘方向,并探討頸胸段前路椎弓根螺釘置入的可行性。方法:調(diào)取自2013年12月至2014年7月行頸椎及上胸椎螺旋螺旋CT掃描示無生理曲度異常、骨質(zhì)破壞、嚴(yán)重退變的完整影像資料50例,其中男性29例,女性21例,年齡23~61歲,平均37.3歲,在原始連續(xù)橫斷面圖像上測量頸胸段椎弓根寬度、椎弓根軸線長度、水平面進針點距離以及進針點所在椎體前緣的分區(qū)、椎弓根軸線的外傾角;利用advantage workstation 4.2工作站對原始連續(xù)橫斷面圖像進行多平面重建,在重建獲得的椎弓根矢狀面像測量頸胸段椎弓根高度、椎體前緣高度、矢狀面進針點距離以及進針點所在椎體前緣的分區(qū)、椎弓根軸線頭/尾傾角,記錄C6~T2椎弓根軸線在胸骨柄上區(qū)、胸骨柄區(qū)及胸骨柄下區(qū)的分布情況,并進行比較分析。結(jié)果:C6~T2椎弓根寬度、高度、椎體前緣高度在性別差異上無統(tǒng)計學(xué)意義;C6~T2水平面進針點距離、矢狀面進針點距離、椎弓根軸線長度兩性差異有統(tǒng)計學(xué)意義(P0.5)。C6~T2水平面進針點距離逐漸增大-0.34~4.75mm;C6矢狀面進針點距離最小5.18±1.02mm,T2矢狀面進針點距離最大9.82±2.28mm。C6~T2椎弓根軸線長度31.01~34.21 mm。相同性別的水平面進針點距離、矢狀面進針點距離在不同椎節(jié)的差異有統(tǒng)計學(xué)意義(P0.5)。C6~T2外傾角、尾傾角在性別差異上無統(tǒng)計學(xué)意義,合并兩性數(shù)據(jù)示C6~T2外傾角逐漸減小46.77°~20.02°;椎弓根軸線在矢狀位上均尾傾,C6~T1尾傾角逐漸減小18.10°~14.54°,而T2尾傾角最大20.62°±5.04°;C6~T2外傾角、尾傾角在不同椎節(jié)的差異有統(tǒng)計學(xué)意義(P0.5)。C6、C7椎弓根軸線穿經(jīng)胸骨柄上區(qū)(A區(qū));T1前路椎弓根軸線主要穿經(jīng)胸骨柄上區(qū)(A區(qū))和胸骨柄區(qū)(B區(qū));T2前路椎弓根軸線穿經(jīng)胸骨柄區(qū)(B區(qū))和胸骨柄下區(qū)(C區(qū))。A、B、C分區(qū)結(jié)果在性別差別上無顯著性差異(P0.05)。結(jié)論:在頸胸段不同椎節(jié),前路椎弓根螺釘置入?yún)?shù)存在差異。理論上通過低位下頸椎前方入路可完成C6、C7、個別T1前路椎弓根螺釘?shù)闹萌?而大部分T1、T2因受限于其前方骨性結(jié)構(gòu)的阻擋,無法通過低位下頸椎前方入路完成前路置釘。
[Abstract]:Objective: to study the position and direction of anterior pedicle screw placement in front of vertebral body. To explore the feasibility of anterior pedicle screw implantation in cervical and thoracic segment. Methods: the spiral CT scan of cervical spine and upper thoracic vertebrae from December 2013 to July 2014 showed no abnormal physiological curvature. There were 50 cases of bone destruction and severe degeneration, including 29 males and 21 females. The age was 2361 years with an average of 37.3 years. The width of cervical and thoracic pedicle, the length of pedicle axis, the distance between horizontal point and the anterior edge of vertebral body, and the angle of external inclination of pedicle axis were measured on the original continuous cross-sectional images. Advantage workstation 4.2 workstation was used to reconstruct the original continuous cross-sectional images. The height of cervical and thoracic pedicle, the height of anterior edge of vertebral body, the distance of insertion point of sagittal plane, the division of anterior edge of vertebral body and the angle of head / tail inclination of pedicle axis were measured in the reconstructed sagittal images. The distribution of the pedicle axis of C _ 6 and T _ 2 in the superior sternum area, the sternal stalk area and the inferior sternum area were recorded and compared and analyzed. Results the pedicle width and height of the pedicle line were compared and analyzed. There was no statistical difference in the height of the anterior edge of the vertebral body between the two sexes. The distance between the point of insertion in horizontal plane and sagittal plane was found in C6 / T 2 plane and sagittal plane respectively. There was significant difference in the length of pedicle axis between the two sexes. The distance of injection point in horizontal plane of P0.5, C6 and T2 gradually increased -0.34 鹵4.75 mm. C6 sagittal plane had the smallest distance of 5.18 鹵1.02 mm. The maximum distance between the insertion point of T 2 sagittal plane was 9.82 鹵2.28 mm. The length of axial line of T 2 pedicle was 31 01 鹵34 21 m. The distance of needle point in horizontal plane was the same as that in horizontal plane of the same sex. There were significant differences in the distance between the insertion points of the sagittal plane and the different vertebrae segments. There was no significant difference in the angle of tail inclination between the two sexes. The combined data showed that the external inclination of C6 / T 2 gradually decreased by 46.77 擄to 20.02 擄; In sagittal position, the axis of pedicle decreased gradually from 18.10 擄to 14.54 擄, while that of T2 to 20.62 擄鹵5.04 擄. There were significant differences in the external inclination angle and tail inclination angle between C6 and T2 in different vertebrae segments. There was a significant difference in the axis of pedicle of C6C7 through the superior sternum area of the sternum. The anterior pedicle axis of T1 mainly passes through the superior sternum area (area A) and the sternal stalk area (area B). T2 anterior pedicle axis through the sternum area (area B) and the substernal pedicle area (area C). There was no significant difference in gender difference in the results of division C (P 0.05). Conclusion: different segments of cervical and thoracic vertebrae. The anterior pedicle screw implantation parameters are different. Theoretically, C6C7 can be completed through the lower anterior cervical approach, and a few T1 anterior pedicle screws can be inserted, while most T1. Due to the limitation of the anterior osseous structure, T2 could not complete the anterior screw through the anterior approach of the lower cervical spine.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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