本文選題：脊柱　切入點(diǎn)：經(jīng)皮椎弓根置釘　出處：《南昌大學(xué)》2015年碩士論文

【摘要】：第一部分:下胸椎與腰椎節(jié)段椎弓根置釘相關(guān)影像學(xué)數(shù)據(jù)的測(cè)量及其臨床意義目的利用下胸椎與腰椎椎弓根的的X片及CT片測(cè)量相關(guān)影像數(shù)據(jù)并進(jìn)行統(tǒng)計(jì)分析,為經(jīng)皮椎弓根置釘和設(shè)計(jì)經(jīng)皮椎弓根置釘定位裝置提供參考依據(jù)。方法收集20例胸腰椎標(biāo)準(zhǔn)正側(cè)位X片(男性10例、女性10例);收集10例下胸椎與腰椎的CT影像數(shù)據(jù)。選擇無(wú)明顯骨缺損及發(fā)育異常的椎體影像為標(biāo)本,節(jié)段為T9-L5椎體。在X片上測(cè)量T9-L5椎弓根進(jìn)針點(diǎn)的距離及兩髂骨最高點(diǎn)連線與各椎弓根進(jìn)針點(diǎn)的距離。在PACS系統(tǒng)中,CT操作界面下進(jìn)行T9-L5的椎弓根的長(zhǎng)度與椎弓根通道的長(zhǎng)度、椎弓根的外傾角與上傾角、椎弓根峽部的高度與寬度的數(shù)據(jù)測(cè)量。結(jié)果在X片上顯示T9-L5椎弓根影的最外側(cè)緣距離逐漸增大,T9-L1增大緩慢,L2-L5增大明顯,男性最大值為66.81mm,女性為63.21mm。男女間各椎體數(shù)據(jù)對(duì)比顯示,男性進(jìn)針點(diǎn)寬度明顯大于女性,兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。左右髂骨最高點(diǎn)連線到進(jìn)針點(diǎn)的距離,男性最遠(yuǎn)為275.32mm,女性為267.49mm,男女間各椎體數(shù)據(jù)對(duì)比,兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí)髂骨最高點(diǎn)連線均大致平L4與L5間隙。CT測(cè)量顯示椎弓根的長(zhǎng)度顯示:L5節(jié)段最短,平均為14.5mm;L2節(jié)段最長(zhǎng),平均為23.3mm,左右椎弓根對(duì)比,無(wú)顯著差異(P0.05);椎弓根通道在T11節(jié)段最短,平均為43.3mm;L2節(jié)段最長(zhǎng),平均為52.4mm,左右兩側(cè)對(duì)比無(wú)顯著差異(PO.05)。T9-T12的椎弓根外傾角呈下降趨勢(shì),從T12至L5呈上升趨勢(shì),T12最小,平均為-1.4°;L5最大,平均為24.9°,左右兩側(cè)對(duì)比,無(wú)顯著差異性(P0.05)。然而T9-L5椎弓根的上傾角呈減小趨勢(shì),T9為最大值,平均為12.9°,L5達(dá)最小值,部分呈現(xiàn)負(fù)角度,平均為-1.1°,左右兩側(cè)的椎弓根角度值對(duì)比,無(wú)顯著差異性(P0.05)。T9-T12椎弓根峽部高度和寬度依次增大,L1-L2節(jié)段稍下降,L2-L5呈遞增趨勢(shì),L5達(dá)最大值,左右對(duì)比無(wú)顯著差異(P0.05),椎弓根峽部的高度較寬度大。結(jié)論下胸椎與腰椎椎弓根的結(jié)構(gòu)雖存在差異,但存在一定規(guī)律,準(zhǔn)確了解椎弓根形態(tài)結(jié)構(gòu)與影像特點(diǎn),為椎弓根螺釘置入裝置設(shè)計(jì)與經(jīng)皮椎弓根螺釘置入提供指導(dǎo)作用,提高手術(shù)安全性與準(zhǔn)確性。第二部分:經(jīng)皮椎弓根置釘定位裝置的設(shè)計(jì)及研制目的研制經(jīng)皮椎弓根置釘定位裝置,為經(jīng)皮椎弓根螺釘置入提供輔助手段。方法根據(jù)椎弓根在X片與CT上的影像特點(diǎn)及其測(cè)量數(shù)據(jù),利用該定位裝置確定椎體與螺釘?shù)目臻g位置,結(jié)合進(jìn)針點(diǎn)和上傾角和外傾角設(shè)計(jì)經(jīng)皮椎弓根置釘定位裝置。結(jié)果經(jīng)皮椎弓根置釘定位裝置制作簡(jiǎn)易,操作方便。結(jié)論經(jīng)皮椎弓根定位裝置可應(yīng)用于臨床以便觀察其對(duì)經(jīng)皮椎弓根置釘術(shù)的應(yīng)用效果。第三部分:經(jīng)皮椎弓根置釘定位裝置在胸腰椎經(jīng)皮椎弓根置釘中的臨床應(yīng)用目的探討經(jīng)皮椎弓根置釘定位裝置在經(jīng)皮椎弓根置釘術(shù)中的臨床應(yīng)用效果。方法收集2014年01月-2014年12月使用經(jīng)皮椎弓根定位裝置定位和克氏針定位的經(jīng)皮椎弓根螺釘置入術(shù)的病例共30例,均為椎體壓縮性骨折的患者,根據(jù)不同定位方法進(jìn)行分組,15例使用經(jīng)皮椎弓根定位裝置定位的為實(shí)驗(yàn)組,另外15例應(yīng)用克氏針進(jìn)行定位的為對(duì)照組,椎弓根螺釘置入的數(shù)量均為60枚。對(duì)比兩組中使用C臂機(jī)的次數(shù)、手術(shù)時(shí)間、螺釘穿破椎弓根數(shù)量,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果在兩組患者中,使用C臂機(jī)的次數(shù)、手術(shù)時(shí)間、螺釘穿破椎弓根數(shù)量,實(shí)驗(yàn)組為18.02±2.19次、103.56±16.12min?、2枚及對(duì)照組為27.35±3.38次、?125.26±15.92min?、4枚。兩組間螺釘穿破椎弓根的數(shù)量?對(duì)比,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);兩組間C臂機(jī)使用次數(shù)、手術(shù)時(shí)間對(duì)比,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論在經(jīng)皮椎弓根螺釘置入術(shù),經(jīng)皮椎弓根定位裝置的應(yīng)用雖不能降低手術(shù)并發(fā)癥的發(fā)生率,但可以減少術(shù)中C臂機(jī)的使用次數(shù)及縮短手術(shù)時(shí)間,?是一種安全有效的定位方法。
[Abstract]:The first part: the lower thoracic and lumbar pedicle screw imaging data measurement and clinical significance of lower thoracic and lumbar pedicle by the measurement of X film and CT film related image data and statistical analysis for percutaneous pedicle screw and percutaneous pedicle screw positioning device provides the reference method. The collection of 20 cases of thoracolumbar standard anteroposterior and lateral X (10 cases, 10 males); collect CT image data of 10 cases of thoracic and lumbar vertebrae. No obvious bone defect and vertebral body image abnormalities were segments of T9-L5 vertebral body. Measuring the needle points on the X film on the T9-L5 pedicle the distance and the two line and the highest point of the iliac pedicle entry point distance. In the PACS system, the length of the pedicle T9-L5 CT interface and the pedicle channel length, angle and angle of pedicle, pedicle isthmus high Data measurement and width. The lateral edge distance T9-L5 pedicle shadow gradually increased display on X, T9-L1 increases slowly, L2-L5 increased obviously, the maximum value is 66.81mm male female, 63.21mm. between male and female vertebral data comparison, male needle width was significantly larger than that of female, there were significant differences between the two group between (P0.05). The highest point is connected to the left iliac needling point distance, as far as male 275.32mm, female 267.49mm, and the vertebral body data comparison, there were statistically significant differences between the two groups (P0.05), and the highest point line of ilium generally flat L4 and L5 gap.CT measurements showed that the pedicle length display L5: the shortest segment, the average is 14.5mm; the L2 segment is the longest, the average is 23.3mm, compared to no significant difference about pedicle, pedicle channel (P0.05); the shortest in the T11 segment, the average is 43.3mm; the L2 segment is the longest, the average is 52.4mm, There was no significant difference between the left and right sides of (PO.05).T9-T12 pedicle angle decreased, increased from T12 to L5 T12 minimum, average -1.4 degrees; the maximum L5, the average is 24.9 degrees, the left and right sides of comparison, no significant difference (P0.05). However, T9-L5 pedicle angle decreased. T9 is the maximum value, the average is 12.9 degrees, L5 reaches a minimum value, part of the negative angle, average -1.1 degrees, between left and right sides of the pedicle angle value, no significant difference (P0.05).T9-T12 isthmus height and width increases, the L1-L2 segment was slightly decreased, L2-L5 increased, L5 reached the maximum value, no significant difference about contrast (P0.05), the isthmus is lower than the width. Conclusion thoracic and lumbar pedicle structure although there are differences, but there are certain rules, accurate understanding of the pedicle morphology and image characteristics, design for pedicle screw insertion device Percutaneous pedicle screw placement and provide guidance, improve the operation safety and accuracy. The second part: percutaneous pedicle screw positioning device design and development objective to develop the percutaneous pedicle screw positioning device, percutaneous pedicle screw placement with aid. Methods according to the imaging features of X and CT in the pedicle and its tablets the measurement data, using the positioning device to determine the location of vertebral body and screw, with the needle point and angle and camber design of percutaneous pedicle screw positioning device. The results of percutaneous pedicle screw positioning device to create a simple, convenient operation. Conclusion percutaneous pedicle positioning device can be used in clinical to observe the application the effect of percutaneous pedicle screw surgery. The third part: percutaneous pedicle screw positioning device for percutaneous pedicle screw in the clinical application of percutaneous pedicle in thoracolumbar spine Pedicle screw positioning device in percutaneous Shiumi Ne nailing clinical effect of surgery. Methods from 2014 December 01 months -2014 years by positioning skin Shiumi Ne positioning device and positioning percutaneous Kirschner Shiumi Ne screw fixation in 30 cases, all patients with vertebral compression fractures, grouped according to different location methods 15 cases with positioning skin Shiumi Ne positioning device for the experimental group, the other 15 cases using Kirschner wire positioning for the control group, the number of Shiumi Ne screw placement was 60. Compared the number of using the C arm machine in the two groups of operation time, the number of screws worn out Shiumi Ne, results were statistically analyzed. In two patients, the number of C arm machine operation time, the number of screws worn out Shiumi Ne, experiment group is 18.02 + 2.19, 103.56 + 2 16.12min?, and the control group is 27.35 + 3.38, 125.26 + 15.92min?? 4, between the two groups. The number of the pedicle? Comparison, no statistically significant difference between the two groups (P0.05); the C arm machine number, operation time comparison, the difference was statistically significant (P0.05). Conclusion percutaneous pedicle screw implantation, application of percutaneous pedicle positioning device can reduce the incidence of complications, but can reduce the intraoperative C arm machine use times and shorten the operation time,? Is a safe and effective method.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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