• 中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院（沈陽，110004） 1 骨科，2 放射科;

【摘 要】 目的 探討術(shù)前二次測(cè)量三維CT重建數(shù)據(jù)在脊柱側(cè)彎矯形術(shù)中的應(yīng)用和臨床意義。 方法 2006年8月－2008年3月收治11例重度僵硬型脊柱側(cè)凸患者，男4例，女7例；年齡15～19歲，平均17.2歲。術(shù)前在軟件操作平臺(tái)上行二次測(cè)量三維CT重建數(shù)據(jù)，根據(jù)測(cè)量結(jié)果選取入釘點(diǎn)位置，選擇合適長(zhǎng)度和直徑的椎弓根螺釘，按測(cè)量角度植入螺釘。共植入197枚螺釘。記錄椎弓根螺釘植入時(shí)間、術(shù)中失血量、術(shù)后神經(jīng)功能狀態(tài)，測(cè)量手術(shù)前后矢狀面、冠狀面Cobb角改變率，術(shù)后CT評(píng)估螺釘植入的準(zhǔn)確性（Andrew分級(jí)）。 結(jié)果 椎弓根螺釘植入時(shí)間為1～11 min，平均5.8 min；術(shù)中失血量為450～2 300 mL，平均1 520 mL。術(shù)后1周內(nèi)復(fù)查X線片，冠狀面Cobb角矯正率68.5%，矢狀面Cobb角矯正率55.5%。術(shù)后1周內(nèi)復(fù)查CT掃描顯示螺釘位置Ⅰ級(jí)77枚（39.1%），Ⅱ級(jí)116枚（58.9%），Ⅲ級(jí)4枚（2.0%）。11例均獲隨訪，隨訪時(shí)間14個(gè)月～2年，無內(nèi)固定物斷裂、移位等并發(fā)癥以及神經(jīng)刺激癥狀發(fā)生。 結(jié)論 術(shù)前二次測(cè)量三維CT重建后的數(shù)據(jù)為脊柱側(cè)彎患者提供了有效的術(shù)中指導(dǎo)，可提高椎弓根植釘準(zhǔn)確率和手術(shù)安全性。

引用本文： 金國(guó)鑫 ,郭文力,李雷,崔少千,段景柱,王歡. 二次測(cè)量三維CT重建數(shù)據(jù)在脊柱側(cè)彎矯形術(shù)中的應(yīng)用. 中國(guó)修復(fù)重建外科雜志, 2012, 26(1): 74-77. doi: 復(fù)制

1. in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
2. Confirmation of an image-based technique for screw placement. Spine (Phila Pa 1976), 1993, 18(13): 1856-1861.
3. J Bone Joint Surg (Am), 1995, 77(8): 1200-1206.
4. computer assisted pedicle screw fixation: a CT analysis. Spine (Phila Pa 1976), 2005, 30(7): 183-190.
5. screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
6. and computer-assisted pedicle screw installation in the thoracic,.
7. lumbar and sacral spine. Spine (Phila Pa 1976), 2000, 25(5): 606-614.
8. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
9. Max Aebi. AO脊柱手冊(cè)——原理與技巧. 陳仲?gòu)?qiáng), 袁文, 主譯. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 2010: 210-285.
10. Rogala EJ, Drummond DS, Gurr J. Scoliosis: incidence and natural history. A prospective epidemiological study. J Bone Joint Surg (Am), 1978, 60(2): 173-176.
11. Kim YJ, Lenke LG, Birdwell KH, et al. Free hand pedicle screw placement.
12. Youkilis AS, Quint DJ, McGillicuddy JE, et al. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery, 2001, 48(4): 771-779.
13. Steinmann JC, Herkowitz HN, el-Kommos H, et al. Spinal pedicl fixation.
14. Vaccaro AR, Rizzolo SJ, Balderston RA, et al. Placement of pedicl screws in the thoracic spine. Part II: An anatomicaland radiographi assessment.
15. Rampersand YR, Pile JH, Salonen D, et al. Clinical accuracy of fluoroscopic.
16. Xu R, Ebraheim NA, Ou Y, et al. Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine (Phila Pa 1976), 1998, 23(9): 1065-1068.
17. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle.
18. Youkilis AS, Quint DJ, McGillicuddy JE, et al. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery, 2001, 48(4): 771-778.
19. Merloz P, Tonetti J, Pittet L, et al. Pedicle screw placement using image guided techniques. Clin Orthop Relat Res, 1998, (354): 39-48.
20. Amiot LP, Lang K, Putzier T, et al. Comparative results between conventional.
21. Amiot LP, Poulin F. Computed tomography-based navigation for hip, knee, and spine surgery. Clin Orthop Relat Res, 2004, (421): 77-86.
22. Holly LT, Foley KT. Percutaneous placement of posterior cervical screws using three-dimensional fluoroscopy. Spine (Phila Pa 1976), 2006, 31(5): 536-541.
23. Mao K, Wang Y, Xiao S, et al. Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. Eur Spine J, 2010, 19(5): 797-802.
24. 陳玉兵, 陸聲, 徐永清, 等. 快速成型個(gè)體化導(dǎo)航模板輔助胸椎椎弓根螺釘置入可行性研究. 中國(guó)矯形外科雜志, 2009, 17(20): 1557-1561.
25. Abul-Kasim K, Ohlin A, Strömbeck A, et al. Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography. Eur Spine J, 2010, 19(1): 96-104.
26. Gstoettner M, Lechner R, Glodny B, et al. Inter- and intraobserver reliability assessment of computed tomographic 3D measurement of pedicles in scoliosis and size matching with pedicle screws. Eur Spine J, 2011, 20(10): 1771-1779.
27. Su P, Zhang W, Peng Y, et al. Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis. Eur Spine J, 2011. [Epub ahead of print].
  1. 1. in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
  2. 2. Confirmation of an image-based technique for screw placement. Spine (Phila Pa 1976), 1993, 18(13): 1856-1861.
  3. 3. J Bone Joint Surg (Am), 1995, 77(8): 1200-1206.
  4. 4. computer assisted pedicle screw fixation: a CT analysis. Spine (Phila Pa 1976), 2005, 30(7): 183-190.
  5. 5. screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
  6. 6. and computer-assisted pedicle screw installation in the thoracic,.
  7. 7. lumbar and sacral spine. Spine (Phila Pa 1976), 2000, 25(5): 606-614.
  8. 8. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
  9. 9. Max Aebi. AO脊柱手冊(cè)——原理與技巧. 陳仲?gòu)?qiáng), 袁文, 主譯. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 2010: 210-285.
  10. 10. Rogala EJ, Drummond DS, Gurr J. Scoliosis: incidence and natural history. A prospective epidemiological study. J Bone Joint Surg (Am), 1978, 60(2): 173-176.
  11. 11. Kim YJ, Lenke LG, Birdwell KH, et al. Free hand pedicle screw placement.
  12. 12. Youkilis AS, Quint DJ, McGillicuddy JE, et al. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery, 2001, 48(4): 771-779.
  13. 13. Steinmann JC, Herkowitz HN, el-Kommos H, et al. Spinal pedicl fixation.
  14. 14. Vaccaro AR, Rizzolo SJ, Balderston RA, et al. Placement of pedicl screws in the thoracic spine. Part II: An anatomicaland radiographi assessment.
  15. 15. Rampersand YR, Pile JH, Salonen D, et al. Clinical accuracy of fluoroscopic.
  16. 16. Xu R, Ebraheim NA, Ou Y, et al. Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine (Phila Pa 1976), 1998, 23(9): 1065-1068.
  17. 17. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle.
  18. 18. Youkilis AS, Quint DJ, McGillicuddy JE, et al. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery, 2001, 48(4): 771-778.
  19. 19. Merloz P, Tonetti J, Pittet L, et al. Pedicle screw placement using image guided techniques. Clin Orthop Relat Res, 1998, (354): 39-48.
  20. 20. Amiot LP, Lang K, Putzier T, et al. Comparative results between conventional.
  21. 21. Amiot LP, Poulin F. Computed tomography-based navigation for hip, knee, and spine surgery. Clin Orthop Relat Res, 2004, (421): 77-86.
  22. 22. Holly LT, Foley KT. Percutaneous placement of posterior cervical screws using three-dimensional fluoroscopy. Spine (Phila Pa 1976), 2006, 31(5): 536-541.
  23. 23. Mao K, Wang Y, Xiao S, et al. Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. Eur Spine J, 2010, 19(5): 797-802.
  24. 24. 陳玉兵, 陸聲, 徐永清, 等. 快速成型個(gè)體化導(dǎo)航模板輔助胸椎椎弓根螺釘置入可行性研究. 中國(guó)矯形外科雜志, 2009, 17(20): 1557-1561.
  25. 25. Abul-Kasim K, Ohlin A, Strömbeck A, et al. Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography. Eur Spine J, 2010, 19(1): 96-104.
  26. 26. Gstoettner M, Lechner R, Glodny B, et al. Inter- and intraobserver reliability assessment of computed tomographic 3D measurement of pedicles in scoliosis and size matching with pedicle screws. Eur Spine J, 2011, 20(10): 1771-1779.
  27. 27. Su P, Zhang W, Peng Y, et al. Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis. Eur Spine J, 2011. [Epub ahead of print].