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目的评价术前X线平片、三维CT重建对于先天性脊柱侧凸患者半椎体周围解剖结构的分辨能力,以完善手术计划,提高手术治疗的目的性。方法对16例先天性脊柱侧凸患者实施后路(6例)或前路(5例)或前后路联合半椎体切除(2例)、软组织松解、器械矫形植骨内固定术,或单纯后路器械矫形植骨融合术(3例)。比较患者术前X线平片、三维CT重建与术中所见关于半椎体周围解剖结构描述的符合率。结果16例患者术前三维CT重建与术中所见关于半椎体畸形前或后面解剖结构特点的描述符合率为16/16。而术前X线平片半椎体前侧和后侧观察结果与术中所见的符合率分别为5/7和1/11。结论先天性脊柱侧凸患者术前X线平片仅能大致了解半椎体前侧的分节情况,而不能准确反映后侧结构的异常情况。三维CT重建可更准确显示半椎体畸形的位置与结构,为完善手术计划提供依据。
Objective To evaluate the ability of preoperative X-ray and three-dimensional CT reconstruction to distinguish the anatomical structures around the hemivertebra in patients with congenital scoliosis so as to improve the surgical plan and improve the purpose of surgical treatment. Methods Sixteen patients with congenital scoliosis underwent posterior approach (6 cases), anterior approach (5 cases), anterior or posterior approach combined hemivertebra resection (2 cases), soft tissue release, orthopedic instrumentation, Simple posterior instrumentation orthopedic fusion (3 cases). Comparisons of preoperative radiographs, three-dimensional CT reconstruction and intraoperative findings on the anatomy around the hemivertebra conforms rate. Results 16 patients with preoperative three-dimensional CT reconstruction and intraoperative findings on the hemivertebra anterior deformity or anatomical features before and after the description was 16/16. The preoperative radiographs of the anterior and posterior hemivertebrae hemispheric observations and intraoperative findings were 5/7 and 1/11, respectively. Conclusions The preoperative radiographs of the patients with congenital scoliosis can only provide general understanding of the anterior segment of the hemivertebra and can not accurately reflect the abnormality of the posterior structure. Three-dimensional CT reconstruction can more accurately show the location and structure of hemivertebra deformity, to provide a basis for the improvement of surgical planning.