螺旋CT对颈椎前路经椎弓根内固定安全性评估

姜 建, 陈, 炤, 刘志礼, 尹庆水, 舒 勇, 黄山虎

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (6) : 658-660.

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (6) : 658-660.
断层影像解剖

螺旋CT对颈椎前路经椎弓根内固定安全性评估

  • 姜 建1, 陈  炤1, 刘志礼1, 尹庆水2, 舒 勇1, 黄山虎1
作者信息 +

The evaluation of spiral CT scans on the safety of cervical anterior transpedicular screw fixation

  • JIANG Jian1, CHEN Zhao1, LIU Zhi-li1,YIN Qing-shui2, SHU Yong1, HUANG Shan-hu1
Author information +
文章历史 +

摘要

目的    探讨CT扫描在下颈椎前路经椎弓根螺钉安全植入中的意义。  方法 取福尔马林浸泡尸体颈椎6具,16层螺旋CT扫描颈椎(C3~7),三维重建测量前路经椎弓根固定相关解剖学参数,根据扫描参数结果选择植入螺钉椎弓根,C形臂X线机透视定位下经前路植入椎弓根钉,CT扫描三维重建分析螺钉位置(根据Tomasino 法评价植钉安全性)。  结果 测量6具尸体颈椎(C3~7),共60个椎弓根,其中有4个椎弓根宽度小于4.0 mm及1个椎弓根的进钉点太靠近椎体上终板而不能植入螺钉,经前路共植入椎弓根钉55枚。根据Tomasino 法评价:在横断位Grade1:52枚, Grade2:2枚, Grade3:1枚;在斜矢状位Grade1:52枚, Grade2:3枚。  结论 术前个体化的CT扫描重建分析颈椎椎弓根形态为经前路颈椎椎弓根钉的安全植入提供保障。

Abstract

Objective To investigate the value of spiral CT on cervical anterior transpedicular screw insertion. Methods The cervical pedicle (C3~7) parameters for anterior transpedicular fixation from six cadaveric specimens were measured under CT scan and three dimensionally reconstructed. Cervical anterior transpedicular screws were implanted into cadaveric pedicles on the basis of the measured parameters. The position of cervical anterior transpedicular screws was evaluated by CT and reconstructing images, followed by the safety evaluation of screws insertion using Tomasino's method. Results In all of 60 pedicles (C3~7) measured, 4 was too small (the width of the pedicle<4.0 mm), and 1 was too closed to the upper plate, to be fixed. 55 screws were implanted successfully. Tomasino's evaluation demonstrated that, , Grade 1, 2 and 3 were 52, 2, and 1 screws in axial plane, and 52, 2, and 3 screws in saggital plane respectively. Conclusions Preoperative spiral CT scan is a valuable evaluation for safe insertion of cervical anterior transpedicular screw.

关键词

颈椎 / 前路 / 椎弓根螺钉 / 椎体切除术 / CT

Key words

Cervical vetebrae / Anterior approach / Pedicle screw / Corpectomy / CT

引用本文

导出引用
姜 建, 陈, 炤, 刘志礼, 尹庆水, 舒 勇, 黄山虎. 螺旋CT对颈椎前路经椎弓根内固定安全性评估[J]. 中国临床解剖学杂志. 2011, 29(6): 658-660
JIANG  Jian, CHEN , ZHAO , LIU Zhi-Li, YIN Qiang-Shui, SHU  Yong, HUANG Shan-Hu. The evaluation of spiral CT scans on the safety of cervical anterior transpedicular screw fixation[J]. Chinese Journal of Clinical Anatomy. 2011, 29(6): 658-660
中图分类号: R323.1    R814.42   

参考文献


[1]  Koller H, Schmidt R, Mayer M, et al.The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping
[J].Eur Spine J, 2010, 19(12): 2137-2148.


[2]  Tomasino A, Parikh K, Koller H, et al. The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood
[J]. J Neurosurg Spine,2010,13 (1):52-60.

[3]  Lu J, Wu X, Li Y, et al. Surgical results of anterior corpectomy in the aged patients with cervical myelopathy
[J]. Eur Spine J, 2008, 17(1): 129-135.

[4]  Komura S, Miyamoto K, Hosoe H, et al. Anterior cervical multilevel decompression and fusion using fibular strut as revision surgery for failed cervical laminoplasty
[J]. Arch Orthop Trauma Surg, 2011,131(9):1177-1185.

[5] Bilbao G, Duart M, Aurrecoechea J, et al. Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies
[J]. Acta Neurochir (Wien),2010,152(7):1155-1163.

[6]  黄山虎,刘志礼,舒勇,等.颈椎前路杂交式减压法治疗多节段脊髓型颈椎病
[J]. 广东医学, 2008,29(3):496.

[7] Kristof RA, Kiefer T, Thudium M, et al. Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy
[J]. Eur Spine J, 2009,18(12):1951-1956.

[8] Kristof RA, Kiefer T, Thudium M, et al. Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy
[J]. Eur Spine J, 2009,18(12):1951-1956.

[9]  Acosta LF, Aryan HE, Chou D, et al. Long-term biomechanical stability and clinical improvement after extended multilevel corpectomy and circumferential reconstruction of the cervical spine using titanium mesh cages
[J]. J Spinal Disord Tech, 2008,21(3):165-174.

[10] Mummaneni PV, Dhall SS, Rodts GE, et al. Circumferential fusion for cervical kyphotic deformity
[J].J Neurosurg Spine,2008,9(6):515-521.

[11] Hart RA, Tatsumi RL, Hiratzka JR,et al. Perioperative complications of combined anterior and posterior cervical decompression and fusion crossing the cervico-thoracic junction
[J]. Spine,2008,33(26):2887-2891.

[12] Yukawa Y, Kato F, Ito K,et al.Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique a Masaaki Machino
[J]. Eur Spine J,2009, 18(6):911-916.

[13] 苏培强,曾时兴,刘尚礼,等.术前CT 测量对颈椎椎弓根形态个体化评价的意义
[J].中国临床解剖学杂志,2007,25 (5):515-517.

[14] 高明,刘庆余,陈建宇,等.CT三维重建技术对颈椎理想椎弓根螺钉的选择及意义
[J].中国临床解剖学杂志,2010,28 (1):61-64.


Accesses

Citation

Detail

段落导航
相关文章

/