| Part I Research for lower thoracic and lumbar percutaneous pedicle screw invasive the relevant of imaging data and its clinical value.Objective : To measure X-ray and CT of lower thoracic and lumbar pedicle imaging data, to provide reference data for percutaneous pedicle screw invasive and design of percutaneous pedicle screw placement positioning device. Methods :Collect data of 20 cases with lower thoracic and lumbar standard positive side X-ray(10 male, 10 female) and 10 cases with lower thoracic and lumbar CT image data.Samples request each vertebral body no obvious dysplasia and bone defect, and contains T9- L5 vertebral body. On the X-ray measurement distance of T9- L5 pedicle screw entry point and two ilium of highest point of attachment line to pedicle screw entry point. To measurements T9- L5 CT data use PACS system, including the length pedicle and the Pedicle chord length, Pedicle Sagittal Angle and Pedicle Transverse Angle, Pedicle Height and Pedicle Width of Pedicle isthmus. Results:The distance of pedicle screw entry point on X-ray images gradually increases from T9 to L5,the increasing is slow from T9 to L1, the increasing is significantly from L2 to L5,the maximum of men is 66.81 mm, female is 63.21 mm. Between men and women vertebrae data comparison shows that men needle point width significantly larger than females, there were significant difference between the men groups(P < 0.05).The distance for two ilium of highest point of attachment line to pedicle screw entry point for male is 275.32 mm, female is 267.49 mm, There were significant difference between the men groups and the women groups among data of the the distance for two ilium of highest point of attachment line to pedicle screw entry point(P < 0.05).Two ilium of highest point of attachment line is roughly flat with L4/L5 clearance.The data of CT show the length of the L5 pedicle is shortest with an average of 14.5mm, longest average 26.3 mm section in L2, there were no significant difference with the left and right sides of pedicle(P > 0.05); Pedicle chord length is the shortest in T11,average of 43.3 mm, the longest in L2 segment average 52.4 mm, there was nosignificant difference with the left and right sides of pedicle(P > 0.05).Pedicle Transverse Angle is decline from T9 to T12, and rise from T12 to L5, minimum average to 1.4 ° in T12, the maximum average 24.9 ° in L5. Pedicle Sagittal Angle presented a decreasing trend From T9 to L5 pedicle of the Angle, the maximum in T9,with an average of 12.9 °, the minimum in L5 average of 1.1 °. there were no significant difference with the left and right sides of pedicle(P > 0.05); Pedicle height and width with Pedicle isthmus was increases from T9- T12, L1 and L2 segments slightly decreased, L2- L5 increasing trend, L5 reaches maximum value. There were no significant difference with the left and right sides of pedicle(P >0.05);Conclusions: lower thoracic and lumbar structure with pedicle were differences,but there is regularity. Accurately understand the characteristics of the pedicle morphology and image, to provide with percutaneous pedicle screw invasive, and improve the safety and accuracy.Part II The design and research for Percutaneous pedicle screw invasive positioning instrument.Objective:Percutaneous pedicle screw invasive positioning instrument auxiliary for percutaneous screw placement. Methods:According to the data with pedicle’s characteristics on image of X-ray and CT,design a instrument to determine pedicle location. Percutaneously pedicle screw invasive positioning instrument was designed according to the character of the entry point and Sagittal Angle and Transverse Angle.Results:The percutaneously pedicle screw invasive positioning instrument simple and easy to use.Conclusion:The percutaneously pedicle screw invasive positioning instrument could be used for the experiment of clinical to percutaneous pedicle screw placement technique to evalute it’s effect.Part III Clinical experimental application of Percutaneous pedicle screw invasive positioning instrument for the technique of minimally invasive percutaneous pedicle screws in thoracolumbar.Objective:Explore the percutaneous pedicle screw invasive positioning instrument clinical outcomes of the technique of minimally invasive percutaneous pedicle screws in treatment of thoracolumbar vertebra fracture. Methods:Colle ct patients underwent MIPPSO from January 2014 to December 2014 were 30 cases,both for the patients with vertebral compression fractures. According th e different localization method to divided randomly into two groups, 15 cases with percutaneous pedicle positioning device positioning as the experimental gr oup, 15 cases of use the needle to locate as the control group, two groups in vasive the number of pedicle screws were 60. ”C” arm fluoroscopic times、op eration time and the number of worn out pedicle screw in two groups were re corded and compared with each other. Results:In two groups of patients, the experimental group use the C arm machine, operation time, number of worn o ut pedicle screw was 17.80 ± 3.46 times, 103.56 ±6.12 min, 2 cases, and the control group was 27.22 ±3.03 times, 125.26 ± 15.92 min, 4 cases. Between t hetwo groups, there were no significant difference with Worn out pedicle scre w number(P > 0.05); there were significant difference with ”C” arm fluoros copictimes and the operation time(P < 0.05).Conclusion:Percutaneous pedicl e invasive positioning device used in percutaneous pedicle screw invasive surge ry cannot avoid the surgical complications, but it can reduce the use of ”C” a rm fluoroscopic times and shorten the operation time, the positioning device is a safe and effective method for positioning. |
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