Analysis of Accuracy and Safety of Pedicle Screw Placement in Patients with Lumbar Spinal Fractures by Screw CT Design
Objective To investigate the parameter change,accuracy and safety of pedicle screw placement in pa-tients with lumbar spinal fractures based on screw channel position in spiral CT images.Methods From January 2020 to Jan-uary 2022,120 patients with lumbar spinal fractures who underwent pedicle screw placement with spiral CT design were se-lected as the observation group,and 120 patients with lumbar spinal fractures who underwent pedicle screw placement with tra-ditional Weinstein method were selected as the control group.Spiral CT was used to determine the parameters of lumbar pedi-cle screw channel in the observation group,and the accuracy and safety of pedicle screw placement,preparation time of screw channels and blood loss during screw placement in the two groups were compared.Results In the observation group,the axis of pedicle was angular with the axis of spinous process in L1～5 segments,and the width of the pedicle was gradually increased(P<0.05).The distance from the insertion point to the anterior vertebral edge at L1～4 segments had no significant change,but decreased significantly at L5 segments(P<0.05).There were no significant differences in the angle between the axis of the pedicle and the axis of the spinous process,the width of the pedicle and the distance between the insertion point and the anterior edge of the vertebral body(P>0.05).The angle between the pedicle axis and the spinous process axis,the width of the pedicle,and the distance from the insertion point to the anterior edge of the vertebral body were greater at L1～5 segments in males than in females(P<0.05,P<0.01).The minimum pedicle width on both sides was(8.13±0.59)mm,which was a safe entry area and could safely accommodate 3.5 mm screws.At 3 days after surgery,spiral CT was re-performed to under-stand the pedicle screw placement of lumbar vertebra.A total of 235 and 229 pedicle screws were inserted in the observation group and the control group respectively.The accuracy and safety rates of observation group were 91.49%(215/235)and 99.15%(233/235)respectively,which were higher than those of control group[72.05%(165/229)and 90.39%(207/229)]respectively(P<0.05).The preparation time of screw channels in the observation group was shorter than that in the control group,and the blood loss during screw placement was less than that in the control group(P<0.01).Conclusion The angle between the pedicle axis and the spine process axis,the width of the pedicle,and the distance from the insertion point to the anterior edge of the vertebral body are different among different segments and between different genders in spiral CT images,which can provide anatomical basis for the placement of lumbar pedicle screws,shorten the preparation time of the screw channel,reduce the amount of blood loss,and improve the accuracy and safety of the placement of screws.
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