下颈椎椎弓根螺钉钉道（Abumi法）X线评估的准确性
摘要
目的：通过回顾性研究探讨在特定判定标准下正、斜位X线位片评估下颈椎椎弓根螺钉钉道(Abumi法)的准确性及可行性。
方法：本研究回顾性地收集了2009年至2012年在我院诊为颈椎疾病(其中颈椎退行性疾病5例,颈椎外伤3例,颈椎肿瘤2例),行下颈椎椎弓根螺钉内固定术并同时具有完善X线、CT扫描及相关重建等相关影像学检查资料的10例病例,其中经Abumi法置入下颈椎椎弓根螺钉44枚,根据文献提供的下颈椎解剖及影像学测量参数,将下颈椎按内倾角度不同分为3组：A组C3-5、B组C6、C组C7(其中A组22枚螺钉,B组12枚螺钉,C组10枚螺钉)。所有患者术后均摄取颈椎正位及双侧45度斜位X线片共3张,并行CT连续平扫+矢状面+冠状面+三维重建(均为骨窗)。X线片判断包括通过观察正位片上螺钉尖端与钩椎关节内外侧边界的关系判断螺钉是否穿破椎弓根内、外侧壁；通过观察对侧45度斜位片上椎弓根的较长径线判断螺钉是否穿破椎弓根上下壁。CT判断包括通过观察轴位的连续断面,判断螺钉全长路径中是否穿破椎弓根内侧、外侧壁；通过观察矢状位重建的连续断面,判断螺钉全长路径中是否穿破椎弓根上下壁。以CT判断结果为标准,分别统计X线判断各组螺钉与椎弓根各侧壁关系的相对敏感性、特异性及准确性,并比较此方法判断椎弓根各侧壁关系的相对准确性在各组间的差异。
结果：本方法判断各组螺钉与椎弓根各壁关系结果与CT扫描及相关重建观察结果相比的相对敏感性及特异性较高(内侧壁敏感性：A组100%、B组100%、C组缺少阳性数据,内侧壁特异性：A组95.5%、B组100%、C组100%,外侧壁敏感性：A组100%、B组88.9%、C组100%,外侧壁特异性：A组100%、B组100%、C组75.0%,上壁敏感性：A组100%、B组100%、C组缺少阳性数据,上壁特异性：A组90.9%、B组100%、C组100%,下壁敏感性：A组缺少阳性数据、B组缺少阳性数据、C组100%,下壁特异性：A组100%、B组100%、C组66.7%)；相对准确性为内侧壁A组95.5%、B组100%、C组100%,外侧壁A组100%、B组91.7%、C组90.0%,上壁A组95.5%、B组100%、C组100%,下壁A组100%、B组100%、C组80.0%；A、C组判断螺钉与下壁间关系的相对准确性存在统计学差异(P＜0.05),其他各侧壁的相对准确性在各组间无统计学差异(P＞0.05)。
结论：本研究提出的经特定判断标准使用正、斜位X线片评价下颈椎椎弓根螺钉钉道的方法,以CT判断结果为标准,其相对敏感性、特异性及准确性较高,且在下颈椎的不同节段均适用,可基本满足临床应用要求,可基本取代CT扫描及相关重建的钉道判断方法,不失为临床工作中一种低放射暴露、经济、快速、准确的钉道判断方法。
Objective:To evaluate the accuracy and feasibility of assessment of subaxial cervical pedicle screw implanted in Abumi's method with anteroposterior and oblique X-ray films using specific standard through retrospective analysis.
Method:Ten patients,who were diagnosed with subaxial diseases,underwent subaxial internal fixation and possessed imaging data of X-ray and CT scan with relative reconstruction,were chosen. The ten patients included five cases of degenerative diseases,three cases of trauma,two cases of neoplastic diseases. All these cases included44subaxial cervical pedicle screws,which were divided into3groups(Group A:C3-5,Group B:C6,Group C:C7),according to the anatomical and imaging parameters of different segments of subaxial cervical pedicles.There were22screws in Group A,12screws in Group B,10screws in Group C.After operation, all the patients underwent X-Ray and CT examination to get the anteroposterior and oblique X-ray films and CT films of the axial,the sagittal and the coronary sections. As to the X-ray assessment,the relationship between screws and superior and inferior walls of pedicles was assessed by the oblique films,which rely on the relatively long radial line on the oblique films;The relationship between screws and medial and lateral walls of pedicles was assessed by the anteroposterior films,with the head of the screw which was located between the medial and lateral margin of uncovertebral joint as the standard.As to the CT assessment,the relationship between screws and superior and inferior walls of pedicles was assessed by the CT films of the consecutive sagittal reconstruction;The relationship between screws and medial and lateral walls of pedicles was assessed by the CT films of consecutive axial section.Then,with the outcome of the CT assessment as the standard,the relative sensitivity,specificity and accuracy of the X-ray assessment were calculated.Meanwhile,the accuracy of the three groups about the relationship between screws and every wall of pedicle was compared.
Result:The relative sensitivity and specificity of the assessment were high(sensitivity about medial wall:Group A100%, Group B100%,Group C lack of positive data;specificity about medial wall:Group A95.5%, Group B100%,Group C100%;sensitivity about lateral wall:Group A100%, Group B88.9%,Group C100%;specificity about lateral wall:Group A100%, Group B100%,Group C75.0%;sensitivity about superior wall:Group A100%, Group B100%,Group C lack of positive data;specificity about superior wall:Group A90.9%, Group B100%,Group C100%;sensitivity about inferior wall:Group A lack of positive data, Group B lack of positive data,Group C100%;specificity about inferior wall:Group A100%, Group B100%,Group C66.7%).The relative accuracy about medial wall was95.5%in Group A,100%in Group B,100%in Group C;The relative accuracy about lateral wall was100%in Group A,91.7%in Group B,90.0%in Group C;The relative accuracy about superior wall was95.5%in Group A.100%in Group B,100%in Group C;The relative accuracy about inferior wall was100%in Group A,100%in Group B,80.0%in Group C.There were no statistically significant differences in accuracy among the3groups,except for the accuracy about inferior wall of Group A and C
Conclusion:This way relying on anteroposterior and oblique X-ray films to assess the accuracy of subaxial cervical pedicle screws,with the CT assessment as the standard,has high relative sensitivity,specificity and accuracy.lt can basically satisfy the clinical need with advantages including low radiation exposure,saving time and money.
方法：本研究回顾性地收集了2009年至2012年在我院诊为颈椎疾病(其中颈椎退行性疾病5例,颈椎外伤3例,颈椎肿瘤2例),行下颈椎椎弓根螺钉内固定术并同时具有完善X线、CT扫描及相关重建等相关影像学检查资料的10例病例,其中经Abumi法置入下颈椎椎弓根螺钉44枚,根据文献提供的下颈椎解剖及影像学测量参数,将下颈椎按内倾角度不同分为3组：A组C3-5、B组C6、C组C7(其中A组22枚螺钉,B组12枚螺钉,C组10枚螺钉)。所有患者术后均摄取颈椎正位及双侧45度斜位X线片共3张,并行CT连续平扫+矢状面+冠状面+三维重建(均为骨窗)。X线片判断包括通过观察正位片上螺钉尖端与钩椎关节内外侧边界的关系判断螺钉是否穿破椎弓根内、外侧壁；通过观察对侧45度斜位片上椎弓根的较长径线判断螺钉是否穿破椎弓根上下壁。CT判断包括通过观察轴位的连续断面,判断螺钉全长路径中是否穿破椎弓根内侧、外侧壁；通过观察矢状位重建的连续断面,判断螺钉全长路径中是否穿破椎弓根上下壁。以CT判断结果为标准,分别统计X线判断各组螺钉与椎弓根各侧壁关系的相对敏感性、特异性及准确性,并比较此方法判断椎弓根各侧壁关系的相对准确性在各组间的差异。
结果：本方法判断各组螺钉与椎弓根各壁关系结果与CT扫描及相关重建观察结果相比的相对敏感性及特异性较高(内侧壁敏感性：A组100%、B组100%、C组缺少阳性数据,内侧壁特异性：A组95.5%、B组100%、C组100%,外侧壁敏感性：A组100%、B组88.9%、C组100%,外侧壁特异性：A组100%、B组100%、C组75.0%,上壁敏感性：A组100%、B组100%、C组缺少阳性数据,上壁特异性：A组90.9%、B组100%、C组100%,下壁敏感性：A组缺少阳性数据、B组缺少阳性数据、C组100%,下壁特异性：A组100%、B组100%、C组66.7%)；相对准确性为内侧壁A组95.5%、B组100%、C组100%,外侧壁A组100%、B组91.7%、C组90.0%,上壁A组95.5%、B组100%、C组100%,下壁A组100%、B组100%、C组80.0%；A、C组判断螺钉与下壁间关系的相对准确性存在统计学差异(P＜0.05),其他各侧壁的相对准确性在各组间无统计学差异(P＞0.05)。
结论：本研究提出的经特定判断标准使用正、斜位X线片评价下颈椎椎弓根螺钉钉道的方法,以CT判断结果为标准,其相对敏感性、特异性及准确性较高,且在下颈椎的不同节段均适用,可基本满足临床应用要求,可基本取代CT扫描及相关重建的钉道判断方法,不失为临床工作中一种低放射暴露、经济、快速、准确的钉道判断方法。
Objective:To evaluate the accuracy and feasibility of assessment of subaxial cervical pedicle screw implanted in Abumi's method with anteroposterior and oblique X-ray films using specific standard through retrospective analysis.
Method:Ten patients,who were diagnosed with subaxial diseases,underwent subaxial internal fixation and possessed imaging data of X-ray and CT scan with relative reconstruction,were chosen. The ten patients included five cases of degenerative diseases,three cases of trauma,two cases of neoplastic diseases. All these cases included44subaxial cervical pedicle screws,which were divided into3groups(Group A:C3-5,Group B:C6,Group C:C7),according to the anatomical and imaging parameters of different segments of subaxial cervical pedicles.There were22screws in Group A,12screws in Group B,10screws in Group C.After operation, all the patients underwent X-Ray and CT examination to get the anteroposterior and oblique X-ray films and CT films of the axial,the sagittal and the coronary sections. As to the X-ray assessment,the relationship between screws and superior and inferior walls of pedicles was assessed by the oblique films,which rely on the relatively long radial line on the oblique films;The relationship between screws and medial and lateral walls of pedicles was assessed by the anteroposterior films,with the head of the screw which was located between the medial and lateral margin of uncovertebral joint as the standard.As to the CT assessment,the relationship between screws and superior and inferior walls of pedicles was assessed by the CT films of the consecutive sagittal reconstruction;The relationship between screws and medial and lateral walls of pedicles was assessed by the CT films of consecutive axial section.Then,with the outcome of the CT assessment as the standard,the relative sensitivity,specificity and accuracy of the X-ray assessment were calculated.Meanwhile,the accuracy of the three groups about the relationship between screws and every wall of pedicle was compared.
Result:The relative sensitivity and specificity of the assessment were high(sensitivity about medial wall:Group A100%, Group B100%,Group C lack of positive data;specificity about medial wall:Group A95.5%, Group B100%,Group C100%;sensitivity about lateral wall:Group A100%, Group B88.9%,Group C100%;specificity about lateral wall:Group A100%, Group B100%,Group C75.0%;sensitivity about superior wall:Group A100%, Group B100%,Group C lack of positive data;specificity about superior wall:Group A90.9%, Group B100%,Group C100%;sensitivity about inferior wall:Group A lack of positive data, Group B lack of positive data,Group C100%;specificity about inferior wall:Group A100%, Group B100%,Group C66.7%).The relative accuracy about medial wall was95.5%in Group A,100%in Group B,100%in Group C;The relative accuracy about lateral wall was100%in Group A,91.7%in Group B,90.0%in Group C;The relative accuracy about superior wall was95.5%in Group A.100%in Group B,100%in Group C;The relative accuracy about inferior wall was100%in Group A,100%in Group B,80.0%in Group C.There were no statistically significant differences in accuracy among the3groups,except for the accuracy about inferior wall of Group A and C
Conclusion:This way relying on anteroposterior and oblique X-ray films to assess the accuracy of subaxial cervical pedicle screws,with the CT assessment as the standard,has high relative sensitivity,specificity and accuracy.lt can basically satisfy the clinical need with advantages including low radiation exposure,saving time and money.
引文
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