利用图像存储传输系统数据库构建下颈椎椎弓根模型及其临床意义

背景：下颈椎椎弓根钉内固定技术具有良好的生物力学强度、三维稳定性和植骨融合率。然而，由于下颈椎解剖结构复杂且个体差异性大，常导致螺钉置入困难，复位风险高。 目的：利用图像存储传输系统结合64排CT片及X射线片于内固定前精确测量下颈椎后方解剖学结构，指导下颈椎内固定过程中椎弓根置钉。 方法：51例下颈椎疾患病例利用图像存储传输系统测量定位法行颈椎椎弓根内固定。同时对比同期开展治疗的两种不同方案的颈椎内固定患者：解剖置钉法26例，管道疏通法17例。以Andrew椎弓根螺钉CT位置分级标准评价3组患者的置钉准确率。 结果与结论：图像存储传输系统测量定位组置钉准确率显著高于其他两组(P < 0.05)，图像存储传输系统测量定位组病例均未发现脊髓、椎动脉、神经等组织损伤。提示应用图像存储传输系统结合64排CT及X射线片内固定前测量，能够指导内固定过程中安全置入颈椎椎弓根螺钉，置钉效果明显强于传统的解剖置钉法及管道疏通法。

Establishing a model of lower cervical spine based on the picture archiving and communication system database and its clinical significance

BACKGROUND: Lower cervical pedicle screw has greater biomechanical strength, higher level of three-dimensional stability and fusion rate of bone graft. However, because the cervical anatomical structure is complicated and has great individual difference, it often leads to screw placement difficulty and surgical risk. OBJECTIVE: Using the picture archiving and communication systems (PACS) combined with 64-slice Helice CT film and X-ray preoperative accurate measurement of cervical rear anatomy structure, to guide the implantation of the cervical pedicle. METHODS: A retrospective review in 51 patients with lower cervical disease was operated suing the PACS measurement localization method with cervical vertebral pedicle internal fixation. Meanwhile, two different cervical vertebral pedicle screw internal fixation of surgery patients were collected for statistics analysis during the same period: (1) Anatomy set of screws method in 26 cases, (2)Pipeline dredge method in 17 cases. All research data above were assessed based on Andrew Scoring System. The practical application and clinical effect were compared using statistical method. RESULTS AND CONCLUSION: The accurate rate for screw location by using PACS measurement localization method was higher than that in the other two groups (P < 0.05). The patients in the PACS measurement localization group had no spinal cord injury, vertebral artery damage, nerve injury, etc. Using the PACS combined with 64-slice Helice CT film and X-ray preoperative accurate measurement of cervical rear anatomy structure before operation can be able to guide the security of implantation of cervical pedicle screws in the operation. Its clinical effect is obviously better than the traditional methods as anatomy set of screws method and pipeline dredge method.