椎弓根皮质骨螺钉固定与传统椎弓根螺钉固定钉道周围骨质CT值比较

CT value of bone in bone-screw interface: comparison between cortical screws and traditional pedicle screws

中文关键词:  椎弓根皮质骨螺钉  传统椎弓根螺钉  钉道  CT值

英文关键词:Pedicle cortical bone trajectory  Traditional pedicle trajectory  CT value  Trajectories

中文摘要:

  【摘要】 目的：比较椎弓根皮质骨螺钉固定与传统椎弓根螺钉固定钉道周围骨质的平均CT值，为椎弓根皮质骨螺钉的应用提供理论依据。方法：调取我院2014年1月~2016年10月21~70岁男女性腰椎高分辨率CT扫描影像资料，每10岁一个年龄组，单组随机抽取30例共300例数据。将各组数据导入Mimics 18.0中进行骨组织三维重建，在L4和L5椎体上模拟椎弓根皮质骨螺钉与传统椎弓根螺钉的置入，分割出各模拟螺钉与骨质相交的感兴趣区域并测量其平均CT值。结果：同年龄段同性别同种置钉方式L4、L5椎体感兴趣区域平均CT值均无统计学差异，皮质骨螺钉置钉与传统椎弓根螺钉置钉钉道周围感兴趣区域的平均CT值21~30岁组男性分别为547.4±48.2Hu和311.1±20.3Hu，女性为517.3±56.0Hu和279.1±41.7Hu；31~40岁组男性分别为519.6±48.9Hu和258.7±26.5Hu，女性为521.5±58.8Hu和287.8±33.2Hu；41~50岁组男性分别为490.9±69.8Hu和249.7±37.5Hu，女性为500.7±81.0和262.0Hu±72.1Hu；51~60岁组男性分别为436.5±65.7Hu和217.4±20.8Hu，女性为438.8±45.8Hu和222.1±22.6Hu；61~70岁组男性分别为396.1±40.0Hu和204.0±36.4Hu，女性为364.5±73.6Hu和153.5±27.1Hu；两种置钉方式各年龄组同性别间比较均有统计学差异（P<0.05），皮质骨螺钉为传统螺钉的1.7~2.3倍。同种置钉方式不同性别间平均CT值比较，传统螺钉置钉在21~30岁、31~40岁和61~70岁组有统计学差异（P<0.05）；皮质骨螺钉置钉在21~30岁和61~70岁组有统计学差异（P<0.05）。结论：椎弓根皮质骨螺钉固定钉道周围骨质CT值明显高于传统椎弓根螺钉固定，椎弓根皮质骨螺钉固定具有更高骨-螺钉界面强度。

英文摘要:

  【Abstract】 Objectives: To compare the CT value of bone in bone-screw interface between cortical screws and traditional pedicle screws, and to provide theoretical basis for the application of cortical screws. Methods: The thin CT scan data were collected from lower lumbar spine of 300 patients, who were stratified by gender and age(at the interval of 10 years). The data of each group were imported into mimics 18.0 software to establish the three dimensional reconstruction models, and cylinders with different diameters were drawn to simulate the different trajectories. The region of interest(ROI) which was in bone-screw interface, was segmented and measured by CT value. Results: There was no statistically significant difference of CT value in ROI of both trajectories between L4 and L5 vertebral bodies in male or female of the same age. The mean CT values in ROI of cortical screws and traditional pedicle screws: 21-30 years group, in male were 547.4±48.2Hu and 311.1±20.3Hu, in female were 517.3±56.0Hu and 279.1±41.7Hu respectively; 21-30 years group, in male were 547.4±48.2Hu and 311.1±20.3Hu, in female were 517.3±56.0Hu and 279.1±41.7Hu respectively; 31-40 years group, in male were 519.6±48.9Hu and 258.7±26.5Hu, in female were 521.5±58.8Hu and 287.8±33.2Hu respectively; 41-50 years group, in male were 490.9±69.8Hu and 249.7±37.5Hu, in female were 500.7±81.0 and 262.0±72.1Hu respectively; 51-60 years group, in male were 436.5±65.7Hu and 217.4±20.8Hu, in female were 438.8±45.8Hu and 222.1±22.6Hu respectively; 61-70 years group, in male were 396.1±40.0Hu and 204.0±36.4Hu, in female were 364.5±73.6Hu and 153.5±27.1Hu respectively. The CT values for two different screw types in same age and gender were significantly different（P<0.05）, and the mean CT values for cortical screws were 1.7-2.3 times higher than those for traditional pedicle screws. The mean CT values within ROI for pedicle cortical bone trajectory between male and female patients were significantly different in the age groups of 21-30 and 61-70(P<0.05), and the differences for traditional pedicle trajectory in 21-30, 31-40 and 61-70 years group also were significant(P<0.05). Conclusions: The mean CT value of bone in bone-screw interface for cortical screws is significantly higher than that of traditional pedicle screws, which shows the higher bone-screw interface strength of cortical screws.