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目的探讨CT三维重建技术术前重建枢椎椎弓根内固定钉道轨迹的方法及其临床意义。方法GELightSpeed 16 Pro螺旋CT扫描完整成人枢椎干燥骨标本15具,在ADW4.2软件上采用容积再现(volume rendering,VR)和多平面重建(multiple planar reformatting,MPR)技术重建和分析图像。在图像工作站中模拟3 mm直径螺钉的经枢椎椎弓根不同方法内固定,观察虚拟螺钉在骨性通道中通行的情况。方法A:进钉点为下关节突根部的中垂线,出至上关节突与齿突交界处。方法B:进钉点为下关节突背侧的头内1/4处,约平行于狭部轴线至上关节突下缘。结果螺钉的轨迹可以从多方位、多角度以及任意3个轴面上得到动态观察。方法A与B两者的钉道长度相近(P>0.05);方法A的上倾角度和内倾角度大于方法B(P值分别为0.0381和0.0001),并有3枚虚拟螺钉穿透横突孔内侧壁,方法B中螺钉均完全在骨性通道中走行,但两者横突孔内侧壁破坏率的差别无统计学意义(P=0.075)。结论CT三维重建技术术前重建枢椎椎弓根内固定可以动态观察螺钉的轨迹是否完全在骨性结构内通行,可以模拟不同进钉点、不同直径的螺钉以及不同角度,在临床治疗和科研中有较大的应用价值。
Objective To explore the method and its clinical significance of preoperative reconstruction of pedicle screw path of pedicle screw with CT three-dimensional reconstruction. Methods The GELightSpeed 16 Pro spiral CT was used to scan 15 intact adult skeletal bone specimens. Images were reconstructed and analyzed on the ADW4.2 software using volume rendering (VR) and multiple planar reformatting (MPR). In the image workstation simulation of 3 mm diameter screw through the pedicle of the pedicle screw fixation, observe the virtual screw in the bony passage of the situation. Method A: The nailing point is the vertical line of the root of the inferior articular process, and the junction of the superior articular process and the tooth process is the same. Method B: into the nail point for the lower back of the dorsal head of the head 1/4, about parallel to the narrow axis to the lower edge of the upper facet. The results of the screw trajectory can be multi-directional, multi-angle and any three axial dynamic observation. Method A and B both had similar pinhole lengths (P> 0.05). Method A was more inclined and angled than method B (P values were 0.0381 and 0.0001, respectively) and three virtual screws penetrated the transverse process The medial wall and the screw in method B all walked completely in the bony passage. However, there was no significant difference in the destruction rate between the two lateral walls (P = 0.075). Conclusion CT three-dimensional reconstruction of preoperative reconstruction of the pedicle screw fixation can dynamically observe the trajectory of the screw is completely within the bony structure can simulate different points into the screw, different diameters of the screw and different angles in clinical treatment and research In the larger application value.