华西医学

华西医学

CT血管造影枢椎椎弓根矢状面术前评估方法的临床应用

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目的探讨 CT 血管造影(CT angiography,CTA)薄层扫描枢椎椎弓根矢状面术前评估在个体化置钉中的应用价值。方法回顾性分析 2016 年 2 月—2017 年 8 月行后路枢椎内固定患者 34 例、68 个椎弓根,术前接受薄层 CTA 扫描。统计椎动脉发育情况;测量并读数枢椎矢状面横突孔处椎弓根高度≥4 mm 连续层数(f);记录枢椎内固定方式;CT 扫描术后椎弓根螺钉钉道;有无椎动脉及脊髓损伤的临床表现,骨折或植骨愈合情况。结果右侧为优势血管者 8 例,左侧为优势血管者 18 例,均衡者 8 例。16 个椎弓根 f>9 层,27 个椎弓根f=9 层,17 个椎弓根 f=8 层,8 个椎弓根 f<8 层。f≥9 层的 43 个椎弓根采用螺钉固定;f=8 层的 17 个椎弓根中,16 个采用椎弓根螺钉固定,1 个采用椎板螺钉固定;f<8 层的 8 个椎弓根中,4 个采用椎弓根螺钉固定,4 个采用椎板螺钉固定。f>9 层的椎弓根螺钉钉道分级 A 级 14 个,B 级 2 个,C 级 0 个;f=9 层的椎弓根螺钉钉道分级 A 级 16 个,B 级 7 个,C 级 4 个;f=8 层的椎弓根螺钉钉道分级 A 级 3 个,B 级 5 个,C 级 8 个;f<8 层的椎弓根螺钉钉道分级 A 级 0 个,B 级 0 个,C 级 4 个;另外 4 个椎板螺钉固定均未侵犯椎管。术后f<8 层的 1 例 C 级患者出现轻度头晕、嗜睡临床表现。术后获得 6~11 个月随访,平均随访(8±3)个月,6 个月以上见骨折或植骨融合。结论基于术前 CTA 薄层扫描,通过读数枢椎 CT/CTA 矢状层面上横突孔处椎弓根高度≥4 mm 连续层数,可以有效判断枢椎椎弓根螺钉的安全性,确定合理的手术方式,从而提高椎弓根固定的成功率,降低手术风险。

ObjectiveTo explore the application value of thin CT angiography (CTA) of pedicle sagittal plane of axis for preoperative evaluation planning pedicle screw placement.MethodsBetween February 2016 and August 2017, 34 patients (68 pedicles) who underwent thin CTA scan before posterior axial surgery were retrospectively analyzed. The vertebral artery development was statistically analyzed. The continuous layers of transverse process hole pedicle height more than or equal to 4 mm (f) were measured and read. The axial fixation methods, clinical manifestations of vertebral artery and spinal cord injury and the bone union of fractures or implants were recorded. Postoperative results of pedicle screws were evaluated by CT scan.ResultsThe right sides of 8 cases and the left sides of 18 cases were dominant vertebral arteries, and equilibrium was reached in 8 cases; f>9 layers were found in 16 pedicles,f=9 layers in 27 pedicles, f=8 layers in 17 pedicles, and f<8 layers in 8 pedicles. The 43 pedicles off≥9 layers used pedicle screw fixation; in the 17 pedicles of f=8 layers, 16 used pedicle screw fixation, and the other one used laminar screw fixation; in the 8 pedicles of f<8 layers, 4 used pedicle screw fixation, and the other 4 used laminar screw fixation. A self-defined pedicle screw grading system was used to evaluate the excellence, and the result showed that,f>9 layers: 14 pedicles were class A, 2 were class B, none was class C;f=9 layers: 16 pedicles were class A, 7 were class B, 4 were class C; f=8 layers: 3 pedicles were class A, 5 were class B, 8 were class C; f<8 layers: none was pedicles class A or class B, 4 were class C. The other 4 lamina screws fixation didn’'t invade the spinal canal. One case of pedicle class C showed clinical manifestations of mild dizziness and drowsiness. The patients were followed up for 6-11 months with an average of (8±3) months, and the fracture or bone graft fusion were observed after 6 months of following-up.ConclusionBased on preoperative CTA thin layer scanning, through measuring and reading continuous layers of transverse process hole pedicle height more than or equal to 4 mm, can effectively judge the security of axial pedicle screws in order to subsequently choose the reasonable operation methods so as to improve success rate and decrease surgical risk.

关键词: 枢椎; 椎动脉; 变异; 计算机薄层血管造影扫描; 椎弓根螺钉; 椎板螺钉

Key words: Axis; Vertebral artery; Variation; Computed tomography angiography; Pedicle screw; Laminar screw

引用本文: 张健, 林旭, 万盛钰, 曾俊, 钟泽莅, 吴超, 谭伦. CT血管造影枢椎椎弓根矢状面术前评估方法的临床应用. 华西医学, 2018, 33(9): 1110-1113. doi: 10.7507/1002-0179.201808052 复制

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