CAJ | 학술논문

目的:探讨脊柱定位尺在胸腰椎后路手术术前定位中的应用价值.方法:2008年6月～2009年10月在C型臂X线机透视下应用自行研制的脊柱定位尺为74例胸腰椎疾病拟行后路手术的患者行术前定位,其中胸腰椎骨折38例,胸腰椎椎管内占位15例,胸腰椎体血管瘤9例,胸腰椎黄韧带骨化症12例.同时每例患者术前分别应用髂前上棘定位法、肋骨定位法、伤椎形态定位法、皮肤标记物定位法和克氏针定位法进行定位.比较不同定位方法的定位准确率、定位时间、透视次数及确定椎弓根穿刺点的准确性,并根据术中探查及术后摄X线片评价定位病椎及椎弓根穿刺点的准确率.结果:应用脊柱定位尺法与髂前上棘定位法、肋骨定位法、伤椎形态定位法、皮肤标记物定位法、克氏针定位法定位病椎的准确率分别为100%、55.4%、87.8%、84.2%、90.5%、91.9%,脊柱定位尺定位法优于传统定位方法(P<0.05);定位时间分别为5.3±1.9min、2.2±0.9min、5.3±1.4min、2.6±1.1min、11.2±2.4min、7.9±1.7min,脊柱定位尺定位法优于皮肤标记物定位法、克氏针定位法(P<0.05),与肋骨定位法无明显差异(P>0.05),长于髂前上棘定位法和伤椎形态定位法(P<0.05);透视次数分别为5.7±1.6次、0次、5.0±1.3次、6.2±1.8次、7.1±2.0次、9.6±2.1次,脊柱定位尺定位法优于皮肤标记物定位法、克氏针定位法(P<0.05),与伤椎形态定位法无明显差异(P>0.05),多于肋骨定位法(P<0.05),髂前上棘定位法不需要透视.应用脊柱定位尺定位法同时能确定椎弓根穿刺点,而传统定位方法不能.结论:脊柱定位尺联合C型臂X线机透视下定位病椎及椎弓根穿刺点准确,是一种较为理想的胸腰椎后路手术术前定位方法.
목적:탐토척주정위척재흉요추후로수술술전정위중적응용개치.방법:2008년6월～2009년10월재C형비X선궤투시하응용자행연제적척주정위척위74례흉요추질병의행후로수술적환자행술전정위,기중흉요추골절38례,흉요추추관내점위15례,흉요추체혈관류9례,흉요추황인대골화증12례.동시매례환자술전분별응용가전상극정위법、륵골정위법、상추형태정위법、피부표기물정위법화극씨침정위법진행정위.비교불동정위방법적정위준학솔、정위시간、투시차수급학정추궁근천자점적준학성,병근거술중탐사급술후섭X선편평개정위병추급추궁근천자점적준학솔.결과:응용척주정위척법여가전상극정위법、륵골정위법、상추형태정위법、피부표기물정위법、극씨침정위법정위병추적준학솔분별위100%、55.4%、87.8%、84.2%、90.5%、91.9%,척주정위척정위법우우전통정위방법(P<0.05);정위시간분별위5.3±1.9min、2.2±0.9min、5.3±1.4min、2.6±1.1min、11.2±2.4min、7.9±1.7min,척주정위척정위법우우피부표기물정위법、극씨침정위법(P<0.05),여륵골정위법무명현차이(P>0.05),장우가전상극정위법화상추형태정위법(P<0.05);투시차수분별위5.7±1.6차、0차、5.0±1.3차、6.2±1.8차、7.1±2.0차、9.6±2.1차,척주정위척정위법우우피부표기물정위법、극씨침정위법(P<0.05),여상추형태정위법무명현차이(P>0.05),다우륵골정위법(P<0.05),가전상극정위법불수요투시.응용척주정위척정위법동시능학정추궁근천자점,이전통정위방법불능.결론:척주정위척연합C형비X선궤투시하정위병추급추궁근천자점준학,시일충교위이상적흉요추후로수술술전정위방법.
Objective:To explore the value of spinal localizer in preoperative localization for posterior thoracolumbar operation.Method:From June 2008 to October 2009,74 patients with thoracolumbar disorders were performed preoperative localization by self-designed spinal localizer combined with C-arm fluoroscopy.There were 38 thoracolumbar vertebrae fractures,15 spinal canal occupant diseases,9 vertebral hemangiomas,12 ossification of ligamentum flavum.Meanwhile each patient was subject to superoanterior iliac spine localization,ribs localization,symptomatic vertebrae appearance localization,skin marker localization,K-wires localization respectively before surgery.The location accuracy,positioning time,radiographic dose and the accuracy of the puncturing site were documented between each localization.The accuracy at involved vertebra and pedicle was investigated by intra-operative and postoperative radiograph.Result:The accurate rate for self-designed spinal localizer localization,superoanterior iliac spine localization,ribs localization,symptomatic vertebra appearance localization,skin marker localization,K-wires localization was 100%,55.4%,87.8%,84.2%,90.5% and 91.9% respectively,with the self-designed spinal localizer localization superior than others(P<0.05).The average localization time was 5.3±1.9min,2.2±0.9min,5.3±1.4min,2.6±1.1min,11.2±2.4min and 7.9±1.7min respectively,with the former superior than skin marker localization,K-wires localization(P<0.05) while similar to ribs localization(P>0.05) and costed longer time than superoanterior iliac spine localization and symptomatic vertebrae appearance localization(P<0.05).The average radiographic dose was 5.7±1.6 times,0 times,5.0±1.3 times,6.2±1.8 times,7.1±2.0 times and 9.6±2.1 times respectively,with the former superior than skin marker localization and K-wires localization(P<0.05) while similar to symptomatic vertebrae appearance localization(P>0.05) and costed more times than ribs localization(P<0.05).The superoanterior iliac spine localization method need no radiographic dose.Spinal localizer localization could localize the anchor point but traditional methods can not.Conclusion:Spinal localizer combined with C-arm fluoroscopy and is an ideal method in preoperative localization for posterior thoracolumbar operation which can localize the symptomatic vertebrae and pedicle.