CAJ | 학술논문

背景:脊椎的轴向旋转是脊柱侧凸的基本畸形之一,由于受后路矫形术野的限制,如何测量脊柱侧凸后路矫形术中患者的脊椎旋转度一直是困扰脊柱外科的难题.目前对脊柱侧凸患者的脊椎旋转度测量多根据患者矫形术前的X射线片或CT进行,而有关矫形术中测量脊椎旋转度的报道甚少.目的:探讨根据椎弓根螺钉的进钉点测量脊椎旋转度的可行性.方法:在经椎弓根中部的CT横切面上测量两侧椎弓根螺钉进钉点连线之垂直平分线与矢状面的夹角(EPPsag角),将EPPsag角与脊椎标本的实际旋转度、Ho's法测量结果进行Wilcoxon符号秩检验.利用重复测量单因素方差分析比较EPPsag角观察者内部和观察者之间的差异.利用脊椎旋转测量仪测量9具腰椎标本在不同位置时的脊椎旋转度,并将上述结果与EPPsag角行配对t检验.结果及结论:EPPsag角与脊椎标本的实际旋转度、Ho's法测量结果差异无显著性意义(p>0.05).重复测量单因素方差分析显示,EPPsag角的观察者内部和观察者之间差异无显著性意义(P>0.05).结果提示,根据EPPsag角来表示脊椎旋转度具有准确性高、可重复性好的优点.当脊椎旋转度不超过30°时,脊椎旋转测量仪可准确反映旋转脊椎的EPPsag角.
배경:척추적축향선전시척주측철적기본기형지일,유우수후로교형술야적한제,여하측량척주측철후로교형술중환자적척추선전도일직시곤우척주외과적난제.목전대척주측철환자적척추선전도측량다근거환자교형술전적X사선편혹CT진행,이유관교형술중측량척추선전도적보도심소.목적:탐토근거추궁근라정적진정점측량척추선전도적가행성.방법:재경추궁근중부적CT횡절면상측량량측추궁근라정진정점련선지수직평분선여시상면적협각(EPPsag각),장EPPsag각여척추표본적실제선전도、Ho's법측량결과진행Wilcoxon부호질검험.이용중복측량단인소방차분석비교EPPsag각관찰자내부화관찰자지간적차이.이용척추선전측량의측량9구요추표본재불동위치시적척추선전도,병장상술결과여EPPsag각행배대t검험.결과급결론:EPPsag각여척추표본적실제선전도、Ho's법측량결과차이무현저성의의(p>0.05).중복측량단인소방차분석현시,EPPsag각적관찰자내부화관찰자지간차이무현저성의의(P>0.05).결과제시,근거EPPsag각래표시척추선전도구유준학성고、가중복성호적우점.당척추선전도불초과30°시,척추선전측량의가준학반영선전척추적EPPsag각.
BACKGROUND: Vertebrae axial rotation is a basic deformity of scoliosis, the rotational degree of which is hard to measure due to the field limitation of posterior spinal instrumentation. Currently, vertebrae rotational degree is measured according to preoperative X-ray film or CT, while no reports concerning measuring vertebrae rotational degree during operation. OBJECTIVE: To explore the feasibility of measurement of vertebrae rotational degree with the entry point of pedicle screws.METHODS: Design of the path of pedicle screws on CT scans before surgery, a line bisection and perpendicular to another connecting bilateral entry point of pedicle screws, and the angle of vertebral rotation (EPPsag) was taken as the angle between this line and the saggital plane. The difference among vertebrae rotational degrees measured by conimeter, Ho's method and EPPsag was compared by Wilcoxon signed rank test. The intra-observer and inter-observer difference was analyzed with One-WayANOVA. Conimeter was used to measure vertebrae rotational degree of each vertebra in 9 lumbar specimens, and the results was compared to EPPsag.RESULTS AND CONCLUSION: There was no significant difference among EPPsag, actual rotational degree and measuring results of Ho's method (P>0.05). The One-Way ANOVA showed that the differences between intra-observer analysis and inter-observer analysis (P>0.05). The results demonstrated that EPPsag can exhibit vertebrae rotational degree accurately and repeatability. This anger can be obtained accurately with the instrument if the vertebrae rotational degree not exceeding 30°.