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目的:探讨螺旋形导针配合双侧斜位X线片判断颈椎椎弓根螺钉置入孔道准确性的可行性。方法:在干燥人C3￣C7标本的椎弓根峡部环扎钢丝,拍摄X线片。做出通过椎弓根中央及破坏椎弓根内、外侧壁种孔3道,插入螺旋形导针,拍摄X线片。分别采用前后位与单侧斜位X线片相结合、单侧斜位X线片及双侧斜位X线片判定导针置入位置,比较X线片判定结果与实际所做孔道的符合率。结果:斜位X线片上,椎弓根椭圆形影是由椎弓根峡部形成的,螺旋形导针在判断椎弓根置入孔道位置时,双侧斜位X线片法的敏感性、特异性和准确性高于前后位与单侧斜位片结合法和单侧斜位片法。前后位与单侧斜位X线片相结合、单侧斜位X线片、双侧斜位X线片三种读片方法判定导针置入位置准确性分别为75.78%、88.89%、93.05%,三者之间存在显著性差异(P<0.05)。判断位于椎弓根中央、穿破内侧椎弓根皮质和穿破外侧皮质这3种孔道位置时,双侧斜位X线片法的准确性分别为90.21%、90.76%、94.74%,高于其它两种读片方法(P<0.05)。结论:螺旋形导针配合双侧斜位X线片用于判断颈椎椎弓根螺钉置入孔道位置的准确性是可行的。
Objective: To investigate the feasibility of using helical guide pins and bilateral oblique X-ray to determine the accuracy of cervical pedicle screw placement. Methods: In the dry C3 ~ C7 specimens of the pedicle isthmus ring wire, X-ray film. Made through the center of the pedicle and the destruction of the pedicle, the lateral wall of the hole 3, insert spiral guide pin, take X-ray film. The anterior and posterior position were combined with unilateral oblique X-ray, the unilateral oblique X-ray and the bilateral oblique X-ray were used to determine the position of the guide needle. The results of X-ray and the actual hole were compared rate. Results: X-ray oblique, elliptical overwhelmed pedicle formed by pedicle isthmus, the spiral guide the needle into the pedicle channel location is determined, the sensitivity of bilateral oblique X-ray method, specific Sex and accuracy than before and after the unilateral oblique film combined with the law and unilateral oblique film method. The anterior and posterior position combined with unilateral oblique X-ray showed that the accuracy of the insertion position of the guiding needle was 75.78%, 88.89% and 93.05 respectively %, There is a significant difference between the three (P <0.05). When the determination is located in the center of the pedicle, perforation of medial cortex of the pedicle cortex and outer perforation position of these three channels, the accuracy of the bilateral oblique X-ray methods were 90.21%, 90.76%, 94.74%, higher than The other two reading methods (P <0.05). Conclusion: It is feasible to determine the accuracy of cervical pedicle screw insertion into the tunnel with spiral guide pin and bilateral oblique X-ray.