本文關鍵詞： 頸椎 骨釘 內固定器 組織工程 骨科植入物 脊柱植入物 下頸椎 椎弓根螺釘 內固定 進釘點 三維重建 CT 測量 關節(jié)突 置釘準確性　出處：《中國組織工程研究》2017年11期 　論文類型：期刊論文

【摘要】：背景:現(xiàn)有的下頸椎椎弓根釘固定技術均以關節(jié)突和側塊為參考標志,由于術者主觀判斷的差異,加之關節(jié)突增生的影響,進釘點的選擇常有一定誤差,易發(fā)生椎動脈或頸髓損傷等嚴重并發(fā)癥,限制了該技術臨床推廣。目前臨床上選擇一個恒定的下頸椎椎弓根釘進釘點標志顯得尤為重要。目的:通過三維重建CT圖像測量明確下頸椎椎弓根釘進釘點與"關節(jié)突間側凹"的定位關系。方法:對排除頸椎畸形的30例患者頸椎行三維重建CT掃描,觀察"關節(jié)突間側凹"的出現(xiàn)率和形態(tài)特征。在重建后的C_3-C_7特定CT圖像上測定以下參數(shù):(1)進釘點至側塊外緣的距離:經雙側椎弓根軸線橫斷面圖像上椎弓根軸線在后柱表面投影點與側塊最外緣的距離;(2)進釘點至"關節(jié)突間側凹"的距離:經單側椎弓根軸線斜矢狀面圖像上椎弓根軸線在后柱表面投影點與"關節(jié)突間側凹"的距離。統(tǒng)計每組參數(shù)的平均值和標準差,并比較各節(jié)段統(tǒng)計數(shù)據(jù)的差異。結果與結論:(1)下頸椎"關節(jié)突間側凹"明顯,出現(xiàn)率為100%,解剖標志恒定且少有增生;(2)利用三維重建CT技術,可以成功獲取C_3-C_7經雙側椎弓根軸線橫斷面和經單側椎弓根軸線斜矢狀面的圖像;(3)在經雙側椎弓根軸線橫斷面圖像上,C_3-C_7左右兩側進釘點至側塊外緣的距離分別為(4.1±0.9)mm和(4.3±0.9)mm,差異無顯著性意義(P=0.609)。除了C_3與C_7、C_4與C_7,各節(jié)段同側測量值的差異均無顯著性意義(P0.05);(4)在經單側椎弓根軸線斜矢狀面的圖像上,C3-C7左右兩側進釘點至"關節(jié)突間側凹"的距離距離分別為(-0.3±1.7)mm和(-0.3±1.6)mm,差異無顯著性意義(P=0.916)。除了C3與C4,各節(jié)段同側測量值的差異均有顯著性意義(P0.05);(5)以上結果提示,下頸椎椎弓根釘進釘點與"關節(jié)突間側凹"在橫斷面上存在相對恒定的定位關系,而在矢狀面上變異較大。
[Abstract]:Background: the existing techniques of pedicle screw fixation of lower cervical vertebrae take the articular process and lateral mass as reference marks. Due to the difference of subjective judgment of the operator and the influence of the proliferation of the articular process, the selection of the point of entry nail is often wrong. Serious complications such as vertebral artery or cervical spinal cord injury are likely to occur. At present, it is very important to select a constant nail point marker for the lower cervical pedicle screw. Objective: to determine the screw point of the lower cervical pedicle by three-dimensional reconstruction CT image measurement. Methods: thirty patients with cervical vertebrae who were excluded from cervical deformities underwent 3D reconstruction CT scanning. To observe the occurrence rate and morphological features of "interarticular facet fovea". The following parameters were measured on the reconstructed C3-CSP 7 specific CT images: the distance between the insertion point and the outer edge of the lateral mass: the axial line of the pedicle through the bilateral pedicle axial line of the vertebrae on the cross-sectional image of the axial line of the pedicle of the vertebral arch. Distance from the projection point on the surface of the posterior column to the outermost edge of the lateral mass to the "lateral concave of the articular process": transpedicular axial line oblique sagittal image of the pedicle axis on the surface of the posterior column and "interarticular facet lateral concave" on the surface of the posterior column. "to count the average and standard deviations of each set of parameters, Results and conclusion the "interarticular facet fovea" of the lower cervical vertebrae was obvious, the occurrence rate was 100, the anatomic mark was constant and there were few proliferative lesions. Images of C _ 3-C _ 7 transpedicular axis cross section and unilateral pedicle axis oblique sagittal plane can be obtained successfully) on bilateral pedicle axis cross-sectional images, the distance between C _ 3-C _ She _ 7 and lateral mass is 4.1 鹵0.9mm, respectively. There was no significant difference between C _ 3-C _ 7 and C _ 7C _ 4 and C _ 7. There was no significant difference in the ipsilateral measurements of each segment between C _ 3-C _ 7 and C _ 7C _ 7. There was no significant difference in the ipsilateral measurements of each segment (P < 0.05). On the images of oblique sagittal plane across the axis of unilateral pedicle, there was no significant difference between C _ 3-C _ 7 and C _ 3-C _ 7 to "interarticular fovea". "the distance of distance was -0.3 鹵1.7 mm and -0.3 鹵1.6 mm, respectively, and there was no significant difference between them. Except for C3 and C4, there were significant differences in ipsilateral measurements of each segment. There was a relatively constant orientation relationship between the nail point of the pedicle of the lower cervical vertebrae and the "interarticular lateral fovea" on the cross section, but there was a great variation on the sagittal plane.
【作者單位】： 南華大學附屬南華醫(yī)院脊柱外科;南華大學附屬南華醫(yī)院放射科;中南大學湘雅三醫(yī)院骨科;
【分類號】：R687.3

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