应用螺旋CT分层扫描及PACS图像分析技术在枢椎个体化置钉手术中的应用

[目的]探讨高速螺旋CT分层扫描及影像存档和通信系统(picture archiving and communication system,PACS)图像分析技术在枢椎个体化置钓手术中的应用价值.[方法]60例共120侧枢椎椎弓根,术前接受螺旋CT分层连续扫描,根据椎动脉孔及椎弓根扫描结果判断椎弓根类型,并测量椎弓根长度,内倾角等指标,为手术提供参考.[结果] 120侧枢椎椎弓根经CT薄扫后,其椎动脉孔分型为:Ⅰ型70侧、Ⅱ型20侧、Ⅲ型18侧、Ⅳ型12侧.选择其中的100侧椎弓根实施螺钉固定,术后CT钉道扫描显示97枚螺钉位于椎弓根管内,位置良好；3枚椎弓根螺钉偏外,指向或进入椎动脉孔.未出现偏向椎管的病例.置钉总成功率97％,置钉失误率3％.[结论]①基于枢椎椎动脉特征型的椎弓根分类判断方法对于判断枢椎椎弓是否适合置钉具有重要价值；②术前对患者枢椎椎弓根进行螺旋CT分层扫描后,测量相关数据,判断枢椎椎弓根的类型,并进行术前钉道设计与测量有助于提高枢椎椎弓根螺钉的置钉成功率.

A study of personal axis pedicle screw placement by thin slice CT scan and PACS technique

[Objective]To investigate the personal pedicle screw placement by thin slice CT scan and measurement by Picture Archiving and Communication System(PACS) preoperatively.[Methods]Sixty patients(120 pedicles) underwent thin slice CT scan before operation,then tile axis pedicles were classified into four types: type I(loose and low),type Ⅱ(tight and high),type Ⅲ(tight and low),type Ⅳ(loose and iligh).The inclination angle(a) of pcdicle screw and the length of pedicle screw paths(1) were measured on PACS respectively.[Results]The whole 60 pedicles account for type Ⅰ(70),type Ⅱ(20),type Ⅲ(18) and type Ⅳ(12).One hundred pedicles underwent pedicle screws placement except 20 pedicles(type Ⅱ).The postoperation CT scan showed that 97 screws were placed rightly.And 3 was screws violated into the vertebrae artery foramen.The success rate was 97%,risk rate of violation into vertebrae artery formen was 3%.[Conclusion]The axis pedicle classification system based on the vertebrate artery formen character is helpful in deciding whether it is fit for pedicle screw fixation or not.②Before operation,some parameters measured on PACS for axis pedicle by thin slice CT scan will be helpful for pedicle screw placement in axis,which is useful to improve on the succeed rate and decrease tile risk greatly.