| 摘要: |
| 目的 通过三维重建CT图像测量参数探讨成人中上胸椎椎弓根钉进钉点（PSEP）与后柱骨性标志的定位关系和变化规律。方法 选取排除了畸形的30例成人中上胸椎CT图像进行三维重建，观察横突椎板凹、横突上嵴和椎板外缘等后柱骨性标志的解剖特征。在重建后的T1~T10特定CT图像上测定以下参数：（1）基础参数，即PSEP至中线的距离（PMD）、横突椎板凹至中线距离（CMD）和半椎板宽度（HLW）；（2）目标参数，即点凹距离（PCD）、进钉点定位比（EPLR）和点嵴距离（PRD）。比较所有参数两侧测量值的差异和基础参数间测量值的差异，总结从T1到T10目标参数测量值的变化规律。结果 中上胸椎横突椎板凹、横突上嵴和椎板外缘具有解剖标志明显、恒定且少有增生的特征。T1~T10左右两侧PMD分别为（14.14±2.63） mm和（14.59±2.58） mm，CMD分别为（10.45±2.12） mm和（10.51±2.02） mm，HLW分别为（16.30±1.48） mm和（16.39±1.61） mm，PCD分别为（4.56±1.03） mm和（4.47±0.94） mm，EPLR分别为0.35±0.26和0.33±0.30，PRD分别为（-1.62±1.90） mm和（-1.63±1.44） mm。所有参数两侧测量值差异均无统计学意义（P>0.05）。除T2中PMD和HLW相比差异无统计学意义（P>0.05），其余节段基础参数间测量值差异均有统计学意义（P<0.01）。从T1到T10，PCD呈现先减小再增大的趋势，T1、T2、T9、T10处PCD均高于T3~T8处（P<0.05）；EPLR呈现先增大再减小的趋势，T1~T3处EPLR与其下方任一节段相比差异均有统计学意义（P<0.01），T4~T6、T10处均低于T7~T9处（P<0.01）；PRD呈现先增大再减小的趋势，T1~T3处PRD与其下方任一节段相比差异均有统计学意义（P<0.01），T4~T6处均低于T7~T10处（P<0.01）。结论 中上胸椎PSEP与横突椎板凹、横突上嵴和椎板外缘等后柱骨性标志存在相对恒定的定位关系和变化规律，可作为一种新的临床上选择进钉点的方法。 |
| 关键词: 中上胸椎 椎弓根螺钉 内固定术 进钉点 三维重建 X线计算机体层摄影术 骨性标志 置钉准确性 |
| DOI：10.16781/j.0258-879x.2017.07.0897 |
| 投稿时间：2016-12-23修订日期：2017-03-25 |
| 基金项目:衡阳市科学技术发展计划（2016KJ45）. |
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| Radiographic measurement for orientation relationships and changing regulations of pedicle screw entry point and posterior bony landmarks in middle-upper thoracic vertebrae of adults |
| LU Zheng-hao1,ZHOU Jing-hua2,WANG Wei-guo3* |
(1. Department of Spinal Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang 421002, Hunan, China;
2. Department of Radiology, Affiliated Nanhua Hospital, University of South China, Hengyang 421002, Hunan, China;
3. Department of Orthopaedics, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, China
*Corresponding author) |
| Abstract: |
| Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images. Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks, including transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina. The following basic parameters, including PSEP-to-midline distance (PMD), transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW), and target parameters, including PSEP-to-transverse process-lamina concave distance (PCD), entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T1 to T10. The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed, and the changing rules of target parameters measurements from T1 to T10 were summarized. Results The transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative. The left and right PMD, CMD, HLW, PCD, EPLR, and PRD were (14.14±2.63) mm and (14.59±2.58) mm, (10.45±2.12) mm and (10.51±2.02) mm, (16.30±1.48) mm and (16.39±1.61) mm, (4.56±1.03) mm and (4.47±0.94) mm, 0.35±0.26 and 0.33±0.30, and (-1.62±1.90) mm and (-1.63±1.44) mm, respectively. There was no significant difference in the measured values between the two sides of the above parameters (P>0.05). Except that the difference between PMD and HLW in T2 was not significant (P>0.05), the differences between basic parameters in the other segments were statistically significant (P<0.05). PCD of T1 to T10 showed a trend of decrease first and then significant increases in T1, T2, T9, and T10 compared with in T3-T8 (P<0.05). EPLR of T1-T10 showed a trend of increase first and then decrease, in which EPLR in T1, T2 and T3 were significantly lower than in the following any segments (P<0.01), and in the T4-T6 and T10 were significantly lower than in T7-T9 (P<0.01). PRD of T1-T10 showed a trend of increase first and then decrease, in which the PRD in T1, T2 and T3 were significantly lower than in the following any segments, and in the T4-T6 were lower than T7-T10 (P<0.01). Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks, such as transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina, and it can serve as a new clinical choice. |
| Key words: middle-upper thoracic vertebrae pedicle screw internal fixation entry point three-dimensional reconstruction X-ray computed tomography measurement landmark screw placement accuracy |
