基于PACS下颈椎侧块钉道长度的影像学三维测量及影响因素分析
|
摘要
目的基于影像归档和通信系统(PACS)测量下颈椎侧块钉道长度并分析其影响因素,为临床置钉提供指导。方法选取2016年12月至2017年12月因颈椎退变或外伤于中国人民解放军北部战区总医院行颈椎手术的100例患者,收集术前颈椎三维CT数据并上传至PAC_S,测量C_3～C_6侧块(LMS)钉道长度,根据身高、体质量、性别、年龄、病因及BMI等因素将其分组并进行比较分析。结果下颈椎C_3～C_6 LMS平均钉道长度为(14. 58±1. 20) mm,与以往研究测量结果基本一致。男、女组LMS平均钉道长度分别为(14. 81±1. 17) mm、(14. 00±0. 28) mm,两者比较差异有统计学意义(P <0. 05)。高体质量组和低体质量组LMS平均钉道长度分别为(14. 84±0. 17) mm、(14. 30±0. 17) mm,两者比较差异有统计学意义(P <0. 05)。不同身高组、病因组、年龄组测量结果显示C_3～C_6部分节段差异有统计学意义(P <0. 05)。不同BMI组LMS钉道长度接近,差异无统计学意义(P> 0. 05)。结论性别、体质量是LMS钉道长度的影响因素,身高、年龄、病因对部分节段LMS钉道长度有影响,可为临床侧块螺钉置钉提供指导。
Objective To measure the length of lateral mass screw( LMS) in lower cervical spine based on the PACS and analyze the affecting factors to provide guidance for clinical screw placement. Methods A total of 100 patients diagnosed with traumatic cervical spine injury or degenerative cervical diseases who underwent cervical spine surgery in general hospital of northern theater command of PLA from December 2016 to December 2017 were selected,and harvested all the data of preoperative patients' three-dimensional cervical CT scan and sent them to PACS. The length of LMS from C_3 to C_6 was gauged separately,then patients were divided into different groups by height,weight,gender,age,pathogenesis and BMI and the data from different groups were compared and analyzed. Results The mean length of LMS from C_3 to C_6 was( 14. 58 ± 1. 20) mm,which was consistent with researches before. The mean length of LMS in male and female respectively were( 14. 81 ±1. 17) mm and( 14. 00 ±0. 28) mm,the difference was significant( P <0. 05). The mean length of group high and group low divided by weight separately were( 14. 84 ± 0. 17) mm and( 14. 30 ± 0. 17) mm,the difference was significant( P < 0. 05). However,the mean length of LMS among those different groups divided by height,age and pathogenesis were not different completely,but for the BMI group,there was no difference( P > 0. 05). Conclusion Gender and weight are affecting factors of length of LMS in subaxial cervical spine,and the length of segmental LMS is affected by height,age and pathogenesis,which can be instructive for the clinical screw placement of LMS.
Objective To measure the length of lateral mass screw( LMS) in lower cervical spine based on the PACS and analyze the affecting factors to provide guidance for clinical screw placement. Methods A total of 100 patients diagnosed with traumatic cervical spine injury or degenerative cervical diseases who underwent cervical spine surgery in general hospital of northern theater command of PLA from December 2016 to December 2017 were selected,and harvested all the data of preoperative patients' three-dimensional cervical CT scan and sent them to PACS. The length of LMS from C_3 to C_6 was gauged separately,then patients were divided into different groups by height,weight,gender,age,pathogenesis and BMI and the data from different groups were compared and analyzed. Results The mean length of LMS from C_3 to C_6 was( 14. 58 ± 1. 20) mm,which was consistent with researches before. The mean length of LMS in male and female respectively were( 14. 81 ±1. 17) mm and( 14. 00 ±0. 28) mm,the difference was significant( P <0. 05). The mean length of group high and group low divided by weight separately were( 14. 84 ± 0. 17) mm and( 14. 30 ± 0. 17) mm,the difference was significant( P < 0. 05). However,the mean length of LMS among those different groups divided by height,age and pathogenesis were not different completely,but for the BMI group,there was no difference( P > 0. 05). Conclusion Gender and weight are affecting factors of length of LMS in subaxial cervical spine,and the length of segmental LMS is affected by height,age and pathogenesis,which can be instructive for the clinical screw placement of LMS.
引文
[1]Ghori A,Le HV,Makanji H,et al. Posterior fixation techniques in the subaxial cervical spine[J]. Cureus,2015,7(10):e338. doi:10. 7759/cureus. 338.
[2]Shinohara A,Sairyo K,Mishiro T,et al. Insertional torque in cervical vertebrae lateral mass screw fixation:magerl technique versus roy-camille technique[J]. Clin Spine Surg,2017,30(8):E1156-E1159. doi:10. 1097/BSD. 0000000000000430.
[3]Katonis P,Papadakis SA,Galanakos S,et al. Lateral mass screw complications:analysis of 1662 screws[J]. J Spinal Disord Tech,2011,24(7):415-420. doi:10. 1097/BSD. 0b013e3182024c06.
[4]Joaquim AF,Mudo ML,Tan LA,et al. Posterior subaxial cervical spine screw fixation:a review of techniques[J]. Global Spine J,2018,8(7):751-760. doi:10. 1177/2192568218759940.
[5]Jeannert B,Magerl F,Ward EW,et al. Posterior stabilization of cervical spine with hook plates[J]. Spine,1991,16(3 suppl):S56-S63. doi:10. 1097/00007632-199103001-00010.
[6] Jónsson H Jr,Rauschning W. Anatomical and morphometric studies in posterior cervical spinal screw-plate systems[J]. J Spinal Disord,1994,7(5):429-438. doi:10. 1097/00002517-199410000-00009.
[7]Sangari SK,Heinneman TE,Conti MS,et al. Quantitative gross and ct measurements of cadaveric cervical vertebrae(c3-c6)as guidelines for the lateral mass screw fixation[J]. Int J Spine Surg,2016,10:43. doi:10. 14444/3043.
[8] Xu R,Ebraheim NA,Nadaud MC,et al. The location of the cervical nerve root on the posterior aspect of the cervical spine[J]. Spine,1995,20(21):2267-2271. doi:10. 1097/00007632-199511000-00001.
[9]Du W,Zhang P,Shen Y,et al. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis[J]. Spine J,2014,14:57-64. doi:10. 1016/j. spinee.2013. 06. 017.
[10]Roy-Camille R,Salient G,Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. The Cervical Spine[M]. 2nd ed. Philadelphia:JB Lippincott,1989:390-403.
[11]Mohamed E,Ihab Z,Moaz A,et al. Lateral mass fixation in sub-axial cervical spine:anatomic review[J]. Global Spine J,2012,2(1):39-46. doi:10. 1055/s-0032-1307261.
[12]Kurd MF,Millhouse PW,Schroeder GD,et al. Lateral mass fixation in the subaxial cervical spine[J]. J Spinal Disord Tech,2015,28(7):259-263. doi:10. 1097/BSD. 0000000000000302.
[13]Yoshihara H,Passias PG,Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws:a systematic review[J]. J Neurosurg Spine,2013,19(5):614-623. doi:10. 3171/2013. 8. SPINE13136.
[14]Abumi K,Shono Y,Ito M,et al. Complication of pedicle screw fixation in reconstructive surgery of the cervical spine[J]. Spine,2000,25:962-969. doi:10. 1097/00007632-200004150-00011.
[15]Nakashima H,Yukawa Y,Imagama S,et al. Complications of cervical pedicle screw fixation for nontraumatic lesions:a multicenter study of84 patients[J]. J Neurosurg Spine,2012,16(3):238-247. doi:10.3171/2011. 11. SPINE11102.
[16]Pait TG,Mc Allister PV,Ksufen HH. Quadrant anatomy of articular pillars(lateral cervical mass)of the cervical spine[J]. J Neurosurg,1995,82(6):1011-1014. doi:10. 3171/jns. 1995. 82. 6. 1011.
[17]Kim DY,Kim JY,Yoon SH,et al. Radiological efficacy of cervical lateral mass screw insertion and rod fixation by modified magerl's method(Yoon's Method)with minimum 2 years of follow-up[J]. Korean J Spine,2012,9(3):137-141. doi:10. 14245/kjs. 2012. 9. 3. 137.
[18]An HS,Gordin RS,Renner K. Anatomic considerations for plate-screw fixation of the cervical spine[J]. Spine,1991,16(10 suppl):S548-S551. doi:10. 1097/00007632-199110001-00019.
[19]Inoue S,Moriyama T,Tachibana T,et al. Cervical lateral mass screw fixation without fluoroscopic control:analysis of risk factors for complications associated with screw insertion[J]. Arch Orthop Trauma Surg,2012,132(7):947-953. doi:10. 1007/s00402-012-1507-6.
[20]魏亦兵,周建伟,张志玉,等.下颈椎后路侧块螺钉固定“两点法”应用解剖研究[J].复旦学报(医学科学版),2005,32(4):423-426.
[21]吉立新,陈仲强,范明富,等.下颈椎侧块安全置钉内固定的解剖学测量[J].中国脊柱脊髓杂志,2008,18(4):286-289. doi:10.3969/j. issn. 1004-406X. 2008. 04. 011.
[22]贾玉华.颈椎侧块的X线和CT测量及其意义[J].中国医学影像学杂志,2004,12(1):69-70. doi:10. 3969/j. issn. 1005-5185.2004. 01. 029.
[2]Shinohara A,Sairyo K,Mishiro T,et al. Insertional torque in cervical vertebrae lateral mass screw fixation:magerl technique versus roy-camille technique[J]. Clin Spine Surg,2017,30(8):E1156-E1159. doi:10. 1097/BSD. 0000000000000430.
[3]Katonis P,Papadakis SA,Galanakos S,et al. Lateral mass screw complications:analysis of 1662 screws[J]. J Spinal Disord Tech,2011,24(7):415-420. doi:10. 1097/BSD. 0b013e3182024c06.
[4]Joaquim AF,Mudo ML,Tan LA,et al. Posterior subaxial cervical spine screw fixation:a review of techniques[J]. Global Spine J,2018,8(7):751-760. doi:10. 1177/2192568218759940.
[5]Jeannert B,Magerl F,Ward EW,et al. Posterior stabilization of cervical spine with hook plates[J]. Spine,1991,16(3 suppl):S56-S63. doi:10. 1097/00007632-199103001-00010.
[6] Jónsson H Jr,Rauschning W. Anatomical and morphometric studies in posterior cervical spinal screw-plate systems[J]. J Spinal Disord,1994,7(5):429-438. doi:10. 1097/00002517-199410000-00009.
[7]Sangari SK,Heinneman TE,Conti MS,et al. Quantitative gross and ct measurements of cadaveric cervical vertebrae(c3-c6)as guidelines for the lateral mass screw fixation[J]. Int J Spine Surg,2016,10:43. doi:10. 14444/3043.
[8] Xu R,Ebraheim NA,Nadaud MC,et al. The location of the cervical nerve root on the posterior aspect of the cervical spine[J]. Spine,1995,20(21):2267-2271. doi:10. 1097/00007632-199511000-00001.
[9]Du W,Zhang P,Shen Y,et al. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis[J]. Spine J,2014,14:57-64. doi:10. 1016/j. spinee.2013. 06. 017.
[10]Roy-Camille R,Salient G,Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. The Cervical Spine[M]. 2nd ed. Philadelphia:JB Lippincott,1989:390-403.
[11]Mohamed E,Ihab Z,Moaz A,et al. Lateral mass fixation in sub-axial cervical spine:anatomic review[J]. Global Spine J,2012,2(1):39-46. doi:10. 1055/s-0032-1307261.
[12]Kurd MF,Millhouse PW,Schroeder GD,et al. Lateral mass fixation in the subaxial cervical spine[J]. J Spinal Disord Tech,2015,28(7):259-263. doi:10. 1097/BSD. 0000000000000302.
[13]Yoshihara H,Passias PG,Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws:a systematic review[J]. J Neurosurg Spine,2013,19(5):614-623. doi:10. 3171/2013. 8. SPINE13136.
[14]Abumi K,Shono Y,Ito M,et al. Complication of pedicle screw fixation in reconstructive surgery of the cervical spine[J]. Spine,2000,25:962-969. doi:10. 1097/00007632-200004150-00011.
[15]Nakashima H,Yukawa Y,Imagama S,et al. Complications of cervical pedicle screw fixation for nontraumatic lesions:a multicenter study of84 patients[J]. J Neurosurg Spine,2012,16(3):238-247. doi:10.3171/2011. 11. SPINE11102.
[16]Pait TG,Mc Allister PV,Ksufen HH. Quadrant anatomy of articular pillars(lateral cervical mass)of the cervical spine[J]. J Neurosurg,1995,82(6):1011-1014. doi:10. 3171/jns. 1995. 82. 6. 1011.
[17]Kim DY,Kim JY,Yoon SH,et al. Radiological efficacy of cervical lateral mass screw insertion and rod fixation by modified magerl's method(Yoon's Method)with minimum 2 years of follow-up[J]. Korean J Spine,2012,9(3):137-141. doi:10. 14245/kjs. 2012. 9. 3. 137.
[18]An HS,Gordin RS,Renner K. Anatomic considerations for plate-screw fixation of the cervical spine[J]. Spine,1991,16(10 suppl):S548-S551. doi:10. 1097/00007632-199110001-00019.
[19]Inoue S,Moriyama T,Tachibana T,et al. Cervical lateral mass screw fixation without fluoroscopic control:analysis of risk factors for complications associated with screw insertion[J]. Arch Orthop Trauma Surg,2012,132(7):947-953. doi:10. 1007/s00402-012-1507-6.
[20]魏亦兵,周建伟,张志玉,等.下颈椎后路侧块螺钉固定“两点法”应用解剖研究[J].复旦学报(医学科学版),2005,32(4):423-426.
[21]吉立新,陈仲强,范明富,等.下颈椎侧块安全置钉内固定的解剖学测量[J].中国脊柱脊髓杂志,2008,18(4):286-289. doi:10.3969/j. issn. 1004-406X. 2008. 04. 011.
[22]贾玉华.颈椎侧块的X线和CT测量及其意义[J].中国医学影像学杂志,2004,12(1):69-70. doi:10. 3969/j. issn. 1005-5185.2004. 01. 029.