腰椎弓根双通道螺钉固定的可行性和准确性研究

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目的:研究腰椎同一椎弓根内置入2枚不同通道螺钉的可行性和准确性。方法:随机选取放射科数据库中2019年3月至2019年10月期间100例腰椎三维CT扫描数据作为研究对象,应用Mimics软件对CT数据进行三维重建,测量椎弓根的松质骨宽度(cancellous bone width,CBW)和松质骨高度(cancellous bone height,CBH),根据椎弓根直径不同选择不同的椎弓根螺钉和翻修螺钉,模拟置入1枚椎弓根螺钉后再置入1枚翻修螺钉,统计在不同腰椎节段椎弓根内置入双通道螺钉的成功率,并测量翻修螺钉的头倾角度和外展角度。结果:Ln 1~Ln 5节段的CBH分别为(10.94±2.22)mm、(9.76±1.82)mm、(9.47±1.77)mm、(8.71±1.52)mm和(8.66±1.62)mm,呈逐渐减小的趋势;Ln 1~Ln 5节段的CBW分别为(5.01±1.61)mm、(5.48±1.69)mm、(6.95±1.79)mm、(8.58±1.85)mm和(11.72±2.25)mm,呈逐渐增大的趋势。Ln 1~Ln 5椎弓根成功地规划了57.2%的双通道螺钉固定,Ln 1椎弓根双通道螺钉置入成功率为100%、Ln 2椎弓根为93.2%、Ln 3椎弓根为79.8%、Ln 4椎弓根为27.6%、Ln 5椎弓根为11.0%,呈逐渐减小的趋势。随着椎弓根松质骨宽度(CBW)的增大,成功率逐渐减小,即4.5 mm≤CBW<6 mm,成功率为91.3%;6 mm≤CBW< 7.5 mm,成功率为83.3%;7.5 mm≤ CBW< 9 mm,成功率为50.7%;9 mm≤CBW<10.5 mm,成功率为19.3%;CBW≥10.5 mm,成功率为15.6%。翻修螺钉的置钉角度:Ln 1~Ln 4的头倾角分别是9.73°±3.96°、9.57°±4.58°、9.13°±4.11°、6.10°±3.00°,外展角分别是9.57°±3.85°、8.76°±4.83°、6.61°±4.93°、5.03°±5.8°,均呈逐渐减小的趋势;Ln 5的头倾角为28.42°±6.06°,外展角为150.58°±2.08°。n 结论:椎弓根松质骨宽度与椎弓根双通道螺钉固定的成功率有关,术前测量CBW对椎弓根双通道螺钉固定的可行性和准确性有重要的意义,数字化模拟置钉为椎弓根双通道螺钉的临床应用了提供参考依据。“,”Objective:To investigate the feasibility and accuracy of inserting two pedicle screws through different trajectories in the same pedicle.Methods:3D image data of 100 adults lumbar spine in the database of radiology department from March 2019 to October 2019 were randomly selected. The cancellous bone width and height of pedicles were measured by using Mimics software. The diameters of pedicle screws and revision screws were chosen according to the width of pedicles. A revision screw was implanted into the same vertebral pedicle after inserting a traditional pedicle screw. The successful rates were analyzed. The head inclination angles and outer inclination angles were measured.Results:1) Pedicle morphology: the height of Ln 1-Ln 5 pedicle cancellous bone were 10.94±2.22 mm, 9.76±1.82 mm, 9.47±1.77 mm, 8.71±1.52 mm, and 8.66±1.62 mm respectively, showing a trend of gradually decreasing. The width of Ln 1-Ln 5 pedicle cancellous bone were 5.01±1.61 mm, 5.48±1.69 mm, 6.95±1.79 mm, 8.58±1.85 mm, and 11.72±2.25 mm respectively, showing a trend of gradually increasing. 2) The successful rates of dual pedicle screws fixation: 57.2% dual pedicle screws fixation were successfully planned in 500 pedicles of 100 people. The successful rates of Ln 1-Ln 5 were 100%, 93.2%, 79.8%, 27.6%, and 11.0% respectively, showing a trend of gradually increasing. As the width of pedicles increased, the successful rates gradually decreased. (3) The angle of revision screws: the head inclination angles of Ln 1-Ln 4 revision screws were 9.73°±3.96°, 9.57°±4.58°, 9.13°±4.11°, and 6.10°±3.00° respectively, showing a decreasing trend; the outer inclination angles were 9.57°±3.85°, 8.76°±4.83°, 6.61°±4.93°, and 5.03°±5.80° respectively, showing a decreasing trend. The head inclination angle of Ln 5 revision screw was 28.42°±6.06° and the outer inclination angle was 150.58°±2.08°.n Conclusion:CBW is related to the successful rate of dual trajectory pedicle screws fixation. Measurement of CBW is of great significance for the feasibility and accuracy of double-channel pedicle screws fixation before operation. The digital simulation of pedicle screw fixation provides reference for the clinical application of double-channel pedicle screws fixation.
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