应用不同影像学检查方法评估椎弓根螺钉位置地研究.docVIP

应用不同影像学检查方法评估椎弓根螺钉位置的研究 作者：李羽中，沈忆新 作者单位：1.江苏省昆山市第一人民医院骨科，江苏 昆山 215300；2.苏州大学附属第二医院骨科，江苏 苏州 215300 　　【摘要】 目的 研究X线片、CT和MRI对术后胸腰椎椎弓根螺钉位置的影像判断特点，选择判断椎弓根螺钉位置准确性的最佳方法。方法 选取6具正常成人尸体脊柱标本(T9～L5)，分别将108个钛合金的椎弓根螺钉植入标本椎弓根，然后分别摄X线片、CT和MRI扫描。随后由不知情的第三者阅片判断各个椎弓钉位置，再逐个轴位横断解剖脊柱标本以检查螺钉的实际植入位置。最后，评估各种评判方案的准确度。结果 X线片组、CT组、MRI组和X线片加CT加MRI联合组的判定灵敏度分别是93.68％、95.79％、93.68％和97.89％。其判定特异度分别是23.08％、53.85％、46.15％和69.23％。其阳性预测值分别是89.90％、93.81％、92.70％和95.88％。阴性预测值分别是33.33％、63.64％、50.00％和81.82％。综合判定X线片组、CT组、MRI组和X线片加CT加MRI联合组的准确度分别是85.19％、90.74％、87.96％和94.44％。结论 对于常规胸腰椎术后患者，单纯应用X线片判定术后椎弓根螺钉位置准确性是比较可靠的，但对于术后出现神经症状者应联合应用X线片加CT加MRI，以提高准确性。 　　【关键词】 椎弓根螺钉；螺钉位置；准确性；影像方案 　　Evaluation of the Position of Thoracolumbar Pedicle Screw with Different Image Method after the OperationLI Chong，SHEN Yixin　1.Department of Orthopaedics，the First Hospital of Kunshan City，Kunshan 215300，China；2.Department of Orthopaedics，the Second Affiliated Hospital of Suzhou University，Suzhou 215300，China Abstract：Objective To study the imaging characteristics of Xray，CT and MRI on determining of postoperative pedicle screw placement，and choose the optimal proposal for judging of pedicle screw positions.Methods 108 titanium pedicle screws were inserted in six normal adult cadaverspine specimens (T9～L5) respectively.The Xray，CT and MRI were obtained，then read by the third parties and judged each pedicle screw position.The spines were then dissected to examine screw location.Finally，evaluated the accuracy of each proposal.Results The sensitivity of Xray，CT，MRI and Xray＋CT＋MRI is 93.68％，95.79％，93.68％ and 97.89％，respectively.the specificity of them is23.08％，53.85％，46.15％and 69.23％，respectively.The positive predictive value is 89.90％，93.81％，92.70％ and 95.88％，respectively.The negative predictive value is 33.33％，63.64％，50.00％ and 81.82％，respectively.The accuracy of Xray，CT，MRI and Xray＋CT＋MRI is equal to 85.19％，90.74％，87.96％and 94.44％ respectively.Conclusion Routine evaluation of patients′ status post ped