| 段伟,谭瑞,甘璐,等.三维CT模拟双通道螺钉置入同一腰椎椎弓根成功率的影响因素分析.骨科,2021,12(2): 103-109. |
| 三维CT模拟双通道螺钉置入同一腰椎椎弓根成功率的影响因素分析 |
| Analysis of influencing factors on implantation of dual trajectory screw in the same lumbar pedicle under 3D CT |
| 投稿时间：2020-10-11 |
| DOI：10.3969/j.issn.1674-8573.2021.02.002 |
| 中文关键词: 腰椎 皮质骨通道螺钉 椎弓根螺钉 三维CT 腰椎融合术 |
| 英文关键词: Lumbar vertebrae Cortical bone trajectory screws Pedicle screws Three-dimensional computed tomography Lumbar fusion |
| 基金项目:国家重点研发计划（2017YFB1104104） |
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| 摘要点击次数: 4084 |
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| 中文摘要: |
| 目的 通过三维CT模拟椎弓根螺钉（pedicle scrw，PS）和皮质骨通道螺钉（cortical bone trajectory，CBT）置入同一腰椎椎弓根，并分析置钉成功率的影响因素。方法 应用Mimics 10.0软件重建49例病人腰椎三维图像，测量双侧L1~L5椎弓根直径（横径和纵径）。将横径及纵径各分为3档，横径：＜8.0 mm、［8.0 mm，12.0 mm）、≥12.0 mm；纵径：＜10.0 mm、［10.0 mm，14.0 mm）、≥14.0 mm。将年龄分为3档：＜40岁、［40岁，60岁）、≥60岁。制定3种不同置钉方案：方案A，先置入PS并固定位置，后置入CBT；方案B，先置入CBT并固定位置，后置入PS；方案C，同时置入PS和CBT，并保持PS偏下、CBT偏上，各螺钉可自行调整进钉点及角度。每个椎弓根均进行3种方案的置钉，统计49例病人共计1 470次置钉的成功次数。按照置钉是否成功进行分组，比较两组间横径、纵径、置钉方案的差异，并采用二元Logistic回归分析模型筛选置钉成功率的独立影响因素。结果 1470次模拟置钉中，23例女性的置钉成功次数为159（159/690，23.04%），26例男性的置钉成功次数为407（407/780，52.18%）。年龄＜40岁者17例，置钉成功次数为247（247/510，48.43%）；年龄为［40岁，60岁）者19例，置钉成功次数为189（189/570，33.16%）；年龄≥60岁者13例，置钉成功次数为130（130/390，33.33%）。单因素分析结果显示置钉成功组和置钉失败组间横径、纵径及置钉方案的差异均有统计学意义（P均＜0.05）。二元Logistic回归分析结果显示椎弓根横径、纵径、置钉方案是置钉成功率的独立影响因素（P均＜0.05）。结论 本研究显示在腰椎同一节段同时置入PS和CBT具有可行性。椎弓根横径及纵径、置钉方案均可影响置钉成功率。双通道螺钉技术可以为脊柱后路内固定手术方式提供更多选择，扩展现有的腰椎内固定方式。 |
| 英文摘要: |
| Objective To analyze the main influencing factors on implantation of cortical bone trajectory and pedicle screw in one lumbar pedicle based on 3D computed tomography. Methods Mimics 10.0 software was applied in this study, and each lumbar pedicle diameter (transverse and longitudinal diameter) was measured. The parameters were divided into three levels according to the different transverse and longitudinal diameters, transverse diameter: ＜8.0 mm, ［8.0 mm, 12.0 mm), ≥12.0 mm; longitudinal diameter: ＜10.0 mm, ［10.0 mm, 14.0 mm), ≥14.0 mm. Three age levels were set up: ＜40 years old, ［40 years old, 60 years old), ≥60 years old. Three plans were developed to simulate screw implantation: for plan A, pedicle screws were first inserted and fixed, followed by cortical bone trajectory screws; for plan B, cortical bone trajectory screws were first inserted and fixed, followed by pedicle screws; for plan C, pedicle screw and cortical bone trajectory screw were inserted simultaneously at the meantime to keep the pedicle screw lower and cortical bone trajectory screw upper. Each pedicle was subjected to screw implantation of three plans. The success amount and rate in each lumbar pedicle under three different screw implantation plans of 49 patients (49×5×2×3 simulating implantations) were calculated. They were divided into two groups according to the success of screw implantation, and the effects of transverse and longitudinal diameter, different screw implantation plans were compared. Binary Logistics regression was used to screen the independent influencing factors of screw implantation success rate. Results In the 1 470 simulating implantations, the number and rate of successful implantations in 23 females was 159 and 23.04% (159/690), and was 407 and 52.18% (407/780) in 26 males respectively, and those were 247 and 48.43% (247/510) in the patients ＜40 years old, 189 and 33.16% (189/570) in the patients with the age of ［40, 60) years old, 130 and 33.33% (130/390) in the patients ≥60 years old respectively. Univariate analysis showed that there were statistically significant differences in transverse diameter, longitudinal diameter and screw implantation plans between the two groups (P＜0.05). Binary Logistics regression showed that transverse diameter, longitudinal diameter, and screw implantation plans were independent risk factors for the success rate (P＜0.05). Conclusion This study suggests implantation of cortical bone trajectory and pedicle screw in one lumbar pedicle is feasible for dual trajectory screws. The pedicle transverse and longitudinal diameter, screw implantation plan can affect the success rate of screw implantation. Dual trajectory screw technology may provide more possibilities for posterior spinal internal fixation and may even extend the existing lumbar fusion. |
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