本文選題：X線 + 下頸椎��； 參考：《山東大學(xué)》2013年碩士論文

【摘要】：目的：通過(guò)回顧性研究探討在特定判定標(biāo)準(zhǔn)下正、斜位X線位片評(píng)估下頸椎椎弓根螺釘釘?shù)?Abumi法)的準(zhǔn)確性及可行性。 方法：本研究回顧性地收集了2009年至2012年在我院診為頸椎疾病(其中頸椎退行性疾病5例,頸椎外傷3例,頸椎腫瘤2例),行下頸椎椎弓根螺釘內(nèi)固定術(shù)并同時(shí)具有完善X線、CT掃描及相關(guān)重建等相關(guān)影像學(xué)檢查資料的10例病例,其中經(jīng)Abumi法置入下頸椎椎弓根螺釘44枚,根據(jù)文獻(xiàn)提供的下頸椎解剖及影像學(xué)測(cè)量參數(shù),將下頸椎按內(nèi)傾角度不同分為3組：A組C3-5、B組C6、C組C7(其中A組22枚螺釘,B組12枚螺釘,C組10枚螺釘)。所有患者術(shù)后均攝取頸椎正位及雙側(cè)45度斜位X線片共3張,并行CT連續(xù)平掃+矢狀面+冠狀面+三維重建(均為骨窗)。X線片判斷包括通過(guò)觀察正位片上螺釘尖端與鉤椎關(guān)節(jié)內(nèi)外側(cè)邊界的關(guān)系判斷螺釘是否穿破椎弓根內(nèi)、外側(cè)壁；通過(guò)觀察對(duì)側(cè)45度斜位片上椎弓根的較長(zhǎng)徑線判斷螺釘是否穿破椎弓根上下壁。CT判斷包括通過(guò)觀察軸位的連續(xù)斷面,判斷螺釘全長(zhǎng)路徑中是否穿破椎弓根內(nèi)側(cè)、外側(cè)壁；通過(guò)觀察矢狀位重建的連續(xù)斷面,判斷螺釘全長(zhǎng)路徑中是否穿破椎弓根上下壁。以CT判斷結(jié)果為標(biāo)準(zhǔn),分別統(tǒng)計(jì)X線判斷各組螺釘與椎弓根各側(cè)壁關(guān)系的相對(duì)敏感性、特異性及準(zhǔn)確性,并比較此方法判斷椎弓根各側(cè)壁關(guān)系的相對(duì)準(zhǔn)確性在各組間的差異。 結(jié)果：本方法判斷各組螺釘與椎弓根各壁關(guān)系結(jié)果與CT掃描及相關(guān)重建觀察結(jié)果相比的相對(duì)敏感性及特異性較高(內(nèi)側(cè)壁敏感性：A組100%、B組100%、C組缺少陽(yáng)性數(shù)據(jù),內(nèi)側(cè)壁特異性：A組95.5%、B組100%、C組100%,外側(cè)壁敏感性：A組100%、B組88.9%、C組100%,外側(cè)壁特異性：A組100%、B組100%、C組75.0%,上壁敏感性：A組100%、B組100%、C組缺少陽(yáng)性數(shù)據(jù),上壁特異性：A組90.9%、B組100%、C組100%,下壁敏感性：A組缺少陽(yáng)性數(shù)據(jù)、B組缺少陽(yáng)性數(shù)據(jù)、C組100%,下壁特異性：A組100%、B組100%、C組66.7%)；相對(duì)準(zhǔn)確性為內(nèi)側(cè)壁A組95.5%、B組100%、C組100%,外側(cè)壁A組100%、B組91.7%、C組90.0%,上壁A組95.5%、B組100%、C組100%,下壁A組100%、B組100%、C組80.0%；A、C組判斷螺釘與下壁間關(guān)系的相對(duì)準(zhǔn)確性存在統(tǒng)計(jì)學(xué)差異(P＜0.05),其他各側(cè)壁的相對(duì)準(zhǔn)確性在各組間無(wú)統(tǒng)計(jì)學(xué)差異(P＞0.05)。 結(jié)論：本研究提出的經(jīng)特定判斷標(biāo)準(zhǔn)使用正、斜位X線片評(píng)價(jià)下頸椎椎弓根螺釘釘?shù)赖姆椒?以CT判斷結(jié)果為標(biāo)準(zhǔn),其相對(duì)敏感性、特異性及準(zhǔn)確性較高,且在下頸椎的不同節(jié)段均適用,可基本滿足臨床應(yīng)用要求,可基本取代CT掃描及相關(guān)重建的釘?shù)琅袛喾椒?不失為臨床工作中一種低放射暴露、經(jīng)濟(jì)、快速、準(zhǔn)確的釘?shù)琅袛喾椒ā?br/>[Abstract]:Objective: to evaluate the accuracy and feasibility of X-ray radiography in evaluating the pedicle screw of lower cervical spine (Abumi method) according to the specific criteria. Methods: from 2009 to 2012, we retrospectively collected 5 cases of cervical degenerative diseases, 3 cases of cervical trauma, and 3 cases of cervical degenerative diseases in our hospital from 2009 to 2012. Two cases of cervical spine tumor were treated with internal fixation of pedicle screw of lower cervical vertebrae and 10 cases with complete X-ray CT scan and related reconstruction. 44 screws of lower cervical pedicle were inserted by Abumi method. According to the anatomical and imaging parameters of the lower cervical vertebrae, the lower cervical vertebrae were divided into 3 groups according to the angle of introversion. The lower cervical vertebrae were divided into 3 groups according to the angle of introversion. All the patients received 3 X-ray films of the cervical vertebrae in positive position and 45 degree oblique position after operation. Three dimensional reconstruction of the coronal plane of the sagittal plane (all bone window. X ray images) with CT scan included observing the relationship between the tip of the screw on the positive film and the inner and outer boundary of the hook joint to determine whether the screw penetrated the medial and lateral wall of the pedicle. By observing the longer diameter of the pedicle on the contralateral 45 degree oblique film to determine whether the screw pierced the upper and lower wall of the pedicle, including observing the continuous cross-section of the axial position, it was determined whether the medial and lateral wall of the pedicle was broken in the full length path of the screw. A continuous section of sagittal reconstruction was observed to determine whether the pedicle wall was broken through the full length of the screw. The relative sensitivity, specificity and accuracy of the relationship between the screw and the lateral wall of the pedicle in each group were statistically analyzed according to the results of CT, and the differences of the relative accuracy of the method in judging the relationship between the lateral wall of the pedicle and the lateral wall of the pedicle were compared. Results: the relative sensitivity and specificity of the relationship between screw and pedicle wall in each group were higher than those of CT scan and related reconstruction. (the sensitivity of medial wall was less in group A than in group B and group C, respectively). The sensitivity of the lateral wall to the lateral wall of group A was 95.5% and that of group B was 100. The sensitivity of the lateral wall was 10: 1. The sensitivity of the lateral wall was 100%. The sensitivity of the lateral wall was 88.9% in group B. The specificity of the lateral wall was 75.0% in group B and 75.0% in group B. The sensitivity of the upper wall was not positive in group A and group B, and there was no positive data in group B. The sensitivity of the inferior wall to the lower wall in group A was lack of positive data, in group B was lack of positive data. In group B, the specific wall of group A was 90.9% and that in group B was 66.7. The relative accuracy was as follows: the medial wall of the lateral wall of group A was 95.5 and that of group B was 100; the lateral wall of group A was 91.7; the upper wall of group A was 90.0; the upper wall of group A was 95.5 and that of group B was 100; the inferior wall of group A was 100 and that of group B was 80.0. There was significant difference in the relative accuracy of the relationship between the screw and the inferior wall in group A (P < 0.05), but there was no significant difference in the relative accuracy of the other lateral walls among the groups (P > 0.05). Conclusion: the method of using positive and oblique radiographs to evaluate the nail passage of pedicle screw of lower cervical vertebrae was put forward in this study. According to the result of CT, the relative sensitivity, specificity and accuracy of the method were high. It can be used in different segments of the lower cervical vertebrae and can basically meet the requirements of clinical application. It can basically replace the method of judging the nail path of CT scan and related reconstruction. It is a kind of low radiation exposure, economical and rapid in clinical work. Accurate judgment method of nail track.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R681.5;R816.8

【共引文獻(xiàn)】

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本文編號(hào)：2028270