多排螺旋CT在胸腰椎椎弓根钉棒系统内固定金属断裂的诊断价值
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摘要
目的探讨多排螺旋CT在胸腰椎椎弓根钉棒系统内固定金属断裂的诊断价值。方法收集2013年1月至2017年12月经手术确诊的胸腰椎椎弓根钉棒系统内固定金属断裂的患者,共19例。患者均行多排螺旋CT检查获得薄层轴位图像,再行多平面重建(MPR)处理获得轴位、矢状位、冠状位图像,并利用表面遮盖(SSD)、容积再现(VR)技术进行三维重建。由两名经验丰富的放射科医师在图像储存与传输系统(PACS)共同阅读CT图像,对比各组图像对内固定金属断裂的显示效果。结果 19例患者,可见22枚螺钉、3条钛棒断裂。其中VR对螺钉及钛棒断裂效果均较好;矢状位图像对螺钉断裂显示效果次之,轴位图像再次,SSD及冠状位图像难以显示螺钉断裂;矢状位及冠状位图像对钛棒断裂显示较好,SSD次之,轴位图像难以显示钛棒断裂。结论多排螺旋CT检查可清晰显示胸腰椎椎弓根钉棒系统内固定金属断裂,其中VR图像对内固定金属断裂显示效果最佳,矢状位重建图像也可显示大部分螺钉及钛棒断裂。
Objective To explore the diagnostic value of multi-slice spiral CT(MSCT) in the breakage of posterior thoracolumbar screw-rod system.Methods Nineteen patients suffering from surgically confirmed breakage of posterior thoracolumbar screw-rod system between January 2013 and December 2017 were enrolled in this study.The MSCT was conducted to obtain the thin-sliced axial images.The multiple planar reconstruction(MPR) was performed to produce the axial,sagittal and coronal images.In addition,three-dimensional reconstructions were carried out with surface shadow display(SSD) and volume rendering(VR).Two experienced radiologists read the CT images in PACS stations to assess the diagnostic effects of different groups of images on breakage of screw-rod system.Results Twenty-two screws and 3 titanium rods broke in the 19 patients.The VR had the optimal efficacy for showing the breakage of both screws and titanium rods.The breakage of screws was well shown on sagittal images,followed by axial images.The SSD and coronal images couldn't display the breakage.The breakage of titanium rods was well displayed on sagittal and coronal images,followed by SSD.The axial images couldn't display the breakage.Conclusion The MSCT can clearly illustrate the breakage of posterior thoracolumbar screw-rod system.The VR provides the best display quality,and the sagittal images show most of the breakage of screws and titanium rods.
Objective To explore the diagnostic value of multi-slice spiral CT(MSCT) in the breakage of posterior thoracolumbar screw-rod system.Methods Nineteen patients suffering from surgically confirmed breakage of posterior thoracolumbar screw-rod system between January 2013 and December 2017 were enrolled in this study.The MSCT was conducted to obtain the thin-sliced axial images.The multiple planar reconstruction(MPR) was performed to produce the axial,sagittal and coronal images.In addition,three-dimensional reconstructions were carried out with surface shadow display(SSD) and volume rendering(VR).Two experienced radiologists read the CT images in PACS stations to assess the diagnostic effects of different groups of images on breakage of screw-rod system.Results Twenty-two screws and 3 titanium rods broke in the 19 patients.The VR had the optimal efficacy for showing the breakage of both screws and titanium rods.The breakage of screws was well shown on sagittal images,followed by axial images.The SSD and coronal images couldn't display the breakage.The breakage of titanium rods was well displayed on sagittal and coronal images,followed by SSD.The axial images couldn't display the breakage.Conclusion The MSCT can clearly illustrate the breakage of posterior thoracolumbar screw-rod system.The VR provides the best display quality,and the sagittal images show most of the breakage of screws and titanium rods.
引文
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[16] 王德娟,钟道强,黄勇,等.多排螺旋CT诊断腹内疝的临床价值[J].实用放射学杂志,2015,31(7):1129-1132,1139.
[2] 贾杰,胡继平.后路椎弓根内固定治疗胸腰椎骨折的并发症分析[J].中国伤残医学,2016,24(20):68-70.
[3] 刘新宇,原所茂,田永昊,等.微创经椎间孔腰椎椎体间融合术内固定相关并发症及对策[J].中华骨科杂志,2016,36(22):1426-1434.
[4] 朱劲松,杨民,徐祝军,等.后路经椎弓根螺钉内固定治疗胸腰椎骨折治疗失败原因分析[J].中华创伤骨科杂志,2016,18(3):253-256.
[5] GALBUSERA F,VOLKHEIMER D,REITMAIER S,et al.Pedicle screw loosening:a clinically relevant complication?[J].Eur Spine J,2015,24(5):1005-1016.
[6] 张晓军,朱斌,郑晓波,等.自动管电流调节联合低电压低剂量扫描技术在幼儿胸部CT扫描中的优化应用研究[J].临床放射学杂志,2016,35(6):946-949.
[7] 张伟,陈伟高.下颈椎椎板螺钉固定技术研究进展[J].南昌大学学报(医学版),2016,56(3):95-97.
[8] 严斌,孙永建,欧阳汉斌,等.3D打印导航模块辅助腰椎椎弓根螺钉精确植入的应用研究[J].中国临床解剖学杂志,2017,35(2):156-159.
[9] 李鑫,张强,赵昌松,等.椎弓根置钉导板导航治疗严重脊柱侧凸手术八例临床观察[J].中华医学杂志,2014,94(11):840-843.
[10] POLLICE S,MUTO M,SCARABINO T.Post-therapeutic imaging findings[J].Eur J Radiol,2015,84(5):799-806.
[11] 唐启瑛,阎作勤,陆秀良,等.320排CT去金属伪影在评价腰椎内固定术后情况的临床价值[J].实用放射学杂志,2015,31(11):1824-1827,1835.
[12] 杨志永.多层面螺旋CT三维重建对脊椎骨折的临床诊断价值研究[J].中国CT和MRI杂志,2016,14(11):118-120.
[13] 王丹,曹绍东,申宝忠,等.64排CT三维透明化重组在内耳畸形诊断中的应用[J].临床放射学杂志,2011,30(1):29-32.
[14] 陈琬,郭翠萍.CT容积漫游技术诊断无名动脉压迫综合征[J].临床放射学杂志,2014,33(1):105-108.
[15] 胡金文,敖炜群,丁景峰,等.MSCTA在冠状动脉起源异常诊断中的价值[J].实用放射学杂志,2018,34(1):82-84,97.
[16] 王德娟,钟道强,黄勇,等.多排螺旋CT诊断腹内疝的临床价值[J].实用放射学杂志,2015,31(7):1129-1132,1139.
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