CN101972165B - X-ray-film-based method for locating coordinates of pedicle screws - Google Patents
X-ray-film-based method for locating coordinates of pedicle screws Download PDFInfo
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- CN101972165B CN101972165B CN2010105480257A CN201010548025A CN101972165B CN 101972165 B CN101972165 B CN 101972165B CN 2010105480257 A CN2010105480257 A CN 2010105480257A CN 201010548025 A CN201010548025 A CN 201010548025A CN 101972165 B CN101972165 B CN 101972165B
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Abstract
The invention relate to an X-ray-film-based method for locating coordinates of pedicle screws, comprising the following steps: measuring transverse diameter, longitudinal diameter and angle of a vertebral pedicle of a centrum on an X-ray plane film; producing a longitudinal extended line A passing the out edge of an vertebral plate by taking thoracic vertebra12-lumbar vertebra 5 as coordinate points; producing a transverse extended line B by midpoints of spinous process midpoint connection lines adjacent to the thoracic vertebra12-lumbar vertebra 5; taking line midpoints of thoracic vertebra zygapophyseal joints as a longitudinal extended line C; taking the line midpoints passing chest 10 spinous process inferior boarder as an extended line D; transferring the intersection point of the extended line A and the extended line B outwards by 4-6mm to reach the locating points of thoracic vertebra12-lumbar vertebra 5; and taking the intersection point of the extended line C and the extended line D as the locating point of the thoracic vertebra 11. The method of the invention is easy to understand and convenient to operate. As the method is completely performed on the X-ray plane film, radioactive injury directly exerted on human body by the traditional location method is overcome. In addition, influence of spinal column regression and variation in anatomy resulting from the traditional method for locating the pedicle screws is reduced and the method features accurate location, high security and high controllability.
Description
Technical field
The present invention relates to a kind of localization method, specifically a kind of pedicle nail coordinate location method based on X-ray film.
Background technology
For some spinal column degeneration and spinal trauma fracture patient; The general normal row way of escape pedicle nail internal fixation technology that needs; The tradition location was adopted following method mostly in the past: advocate to locate into nail along vertebral body superior articular process outer rim vertical line and transverse process bisector intersection point for lumbar vertebra: 1.Mager (1986); Parallel with terminal plate of vertebral body and become 15 ° of angles with sagittal plane, to the inside under pedicle to the vertebral body frontal cortex.2.Roy-Camille (1986) suggestion is advanced nail with the extended line of articular process vertical line and transverse process bisector intersection point, and is parallel with soleplate about the vertebral body and along the sagittal plane straight line forward, do not become the angle to the inside, the degree of depth is 50%～60% of a vertebral body anteroposterior diameter.3.Krag (1986) select for use entry point outer slightly, 2/3 reaches 1/3 intersection point down on transverse process, goes up inwardly, but does not pass terminal plate of vertebral body.4.Weinstein (1988) propose to advance nail by superior articular process's outer inferior horn.5.AO it is entry point that method is recommended the angle of cut place with superior articular process and transverse process, slopes inwardly 5 ° in breast waist section, tilts 10 °～15 ° in 5 in waist 2～waist.6. Chen Yao right (1982) advocates to stress to get into from sagittal plain for advancing the nail sign in outer 1mm place down with superior articular process's external lower margin to waist 1～waist 3.7. it is entry point at waist 1～waist 4 with the intersection point of the anapophysis upper horizontal line of superior articular process's mid point vertical line and transverse process that single cloud official (1988) proposes " cross positioning mode "; The bosom is an entry point between 5 in waist is with mastoid process and anapophysis, and 2 kinds of different parts are tilted 2 °～5 ° and 15 ° respectively to the inside.8. Zheng ancestral root (1988) proposition vertical line of above inferior articular surface and transverse process centrage intersection point advance nail.
For thoracic vertebra: the thoracic vertebra entry point that domestic Shi Yamin etc. are recommended is following: T1～4 entry points in the transverse process root on 1/3; T5～9 are at transverse process root upper limb; T10～12 are at transverse process root mid point, and the entry point of mentioning thoracic vertebral pedicle during Jia Lianshun chief editor's modern spinal surgery is learned is at line between the portion between transverse process basilar part and articular process.Can find out that above the whole bag of tricks mainly is that different axis and the tangent line that centers on transverse process and articular process proposes.
When above traditional method is handled the tangible patient of spinal column hypertrophy regression for the especially young doctor of clinicist; The location no small deviation can occur when advancing to follow closely; Especially for the tangible patient of regression, the zygapophysial joints hypertrophy is obviously loose, in appearance is located partially easily or partially; Some transverse process is not a rule very, on the feeler inspection transverse process, occurs the location during lower edge easily on the upper side or on the lower side.And when lower edge is touched on the transverse process in spy, need peel off and appear transverse process and very easily damage the petty action network of vein around the transverse process, this will certainly increase the amount of bleeding in the art.Fracture of transverse process can appear in some vertebral body in some traumatic spinal injuries, also can increase the pedicle of vertebral arch positioning difficulty.Especially the abundant clinician of those experiences, and exist difference between the individuality localized deviation occurs during in the face of above situation easily, this shows that lumbar vertebra is used for traditional pedicle of vertebral arch witness marker and has more drawback.
Summary of the invention
The objective of the invention is to drawback to prior art; A kind of pedicle nail coordinate location method based on X-ray film is provided; This method is to locate the basis with the X-ray film, and CT confirms localized coordinate points on the X-ray sheet in conjunction with the crown position of pedicle of vertebral arch, and method is simple, science, accurate.
Realize that the foregoing invention purpose adopts following technical scheme: a kind of pedicle nail coordinate location method based on X-ray film, this method serves as the basis, location with the X-ray plain film, its localization method comprises the steps: on the X-ray plain film:
A. measure the transverse diameter and vertical footpath and angle of the pedicle of vertebral arch of vertebral body;
B. be coordinate points with specific anatomical point on thoracic vertebra 12～lumbar vertebra 5, be extend longitudinally line A through its vertebral plate outer rim;
C. be extending transversely line B through the mid point of thoracic vertebra 12～lumbar vertebra 5 adjacent spinous mid point lines;
D. be extend longitudinally line C through line mid point between thoracic vertebra 10 zygapophysial jointss;
E. through breast 10～11 spinous process lower edges be extending transversely line D,
The intersection point of f.A line and B line moves the anchor point that 4～6mm is breast 12～waist 5 vertebras outward;
The intersection point of g.C line and D line is the anchor point of breast 11 vertebras.
Adopt technique scheme, compared with prior art, this method is easily understood and is convenient to operation.Because this method is operated on the X-ray plain film fully, has thoroughly overcome the radiation injury that traditional location directly acts on human body.Reduced the spinal column regression that the positioning mode of traditional pedicle nail faces and the influence of anatomical variation, accurate positioning, safety and controllability are high.
Description of drawings
Fig. 1 is the along slope coordinate sketch map of X-ray sheet vertebral plate outer rim of the present invention.
Fig. 2 is the lateral coordinates sketch map of adjacent spinous mid point among the sheet X-ray of the present invention.
Fig. 3, Fig. 4, Fig. 5 are the present invention confirms anchor point in sheet X-ray sketch maps.
The specific embodiment
Below in conjunction with accompanying drawing the present invention is done further description.
Present embodiment is a kind of pedicle of vertebral arch coordinate location method based on the X-ray sheet, and this method is a subject matter with the X-ray sheet, on the X-ray sheet, chooses coordinate points, confirms the into anchor point of nail.Concrete steps are referring to accompanying drawing 1-5.
At first arrange the X-ray line sheet of thoracic vertebra, lumbar vertebra, perhaps do the CT scan sheet to the patient.It is subject matter that present embodiment is got X-ray film.
On the X-ray or CT sheet that show thoracic vertebra, lumbar vertebra; Measuring the transverse diameter and vertical footpath and angle of the pedicle of vertebral arch of vertebral body, see Fig. 1, is coordinate points with the point of the specific anatomical on thoracic vertebra 12～lumbar vertebra 5 (vertebral plate outer rim); Be extend longitudinally line A through its vertebral plate outer rim; Just be extend longitudinally line A through the vertebral plate outer rim of breast 12～lumbar vertebra 5, through the medial border of pedicle of vertebral arch, promptly vertebral plate outer rim F is the inner edge of pedicle of vertebral arch to this A line just.Be pedicle of vertebral arch axis A1, the A line of vertebral plate outer rim F is through pedicle of vertebral arch medial border and parallel with pedicle of vertebral arch axis A1.
See Fig. 2,, make parallel the next terminal plate of vertebral body extended line B line, i.e. extending transversely line B through the mid point of corresponding neighbouring vertebral body spinous process mid point line between thoracic vertebra 12～lumbar vertebra 5 vertebral bodys.In 1/3 scope (losing the shape position the pedicle of vertebral arch trisection), see Fig. 3 in the pedicle of vertebral arch of this B line through the next vertebral body, the intersection point of A line and B line is the anchor point E of thoracic vertebra 12～lumbar vertebra 5, outside anchor point E, moves 4～6mm to E1 point, and this point is the entry point of pedicle nail.
See Fig. 4, Fig. 5; Make extend longitudinally line C line through line mid point between the zygapophysial joints of thoracic vertebra 10 and thoracic vertebra 11; This line is the axis of the mistake shape position of thoracic vertebral pedicle; Through thoracic vertebra 10 spinous process lower edges and be parallel to the extending transversely line D line of thoracic vertebra 11 soleplates, this line pass through just thoracic vertebra 11 pedicles of vertebral arch in 1/3 scope.The intersection point E2 point of C line and D line then is the entry point of the pedicle of vertebral arch of thoracic vertebra 11.
Operation embodiment according to said method:
Embodiment 1: lumbar vertebra 2 vertebral fractures need the way of escape to cut the pedicle nail internal fixation, need to confirm lumbar vertebra 1 and lumbar vertebra 3 pedicle of vertebral arch entry points.On the X-ray sheet; Find out the vertebral plate outer rim of lumbar vertebra 1 and lumbar vertebra 3; Confirm that (the extend longitudinally line through the vertebral plate outer rim passes through the inner edge of pedicle of vertebral arch just for the pedicle of vertebral arch medial wall of lumbar vertebra 1 and lumbar vertebra 3; This line is above-mentioned A line); Confirm the mid point of " thoracic vertebra 12, lumbar vertebra 1 " and the spinous process mid point line of " lumbar vertebra 2, lumbar vertebra 3 ", (available single finger level is disposed across on the supraspinal ligament in spinous process gap in the art, makes it to be in the spinous process centre position to do the parallel lines of parallel the next terminal plate of vertebral body through its mid point then; The bisector of finger then just well pedicle of vertebral arch in 1/3) this line is the B line, the intersection point E point of A line and B line is outer, and to move 4～6mm (can be more accurate according to 1/2 value of pedicle of vertebral arch transverse diameter in crown CT image of pedicle of vertebral arch before the art) be that the E1 point can be accurately and simply find the accurate entry point of waist 1 and waist 3 pedicle nails.See Fig. 1,2,3.And thoracic vertebra 12～lumbar vertebra 5 each vertebral body pedicle nail entry point can the rest may be inferred.
Embodiment 2: when thoracic vertebra 12 vertebral fractures need the way of escape to cut the pedicle nail internal fixation, clap the X-ray sheet earlier, on the X-ray sheet, confirm thoracic vertebra 11 and lumbar vertebra 1 pedicle of vertebral arch entry point (lumbar vertebra 1 pedicle of vertebral arch entry point is described).Make extend longitudinally line C line (axis of the mistake shape position of this line through thoracic vertebral pedicle) through line mid point between the zygapophysial joints of thoracic vertebra 10 and thoracic vertebra 11, the extending transversely line D line through thoracic vertebra 10 spinous process lower edges (this line pass through just breast 11 pedicles of vertebral arch in 1/3 scope).The intersection point E2 point of C line and D line then is the pedicle nail entry point of thoracic vertebra 11.See Fig. 4,5.
The vertebral plate outer rim of the zygapophysial joints of thoracic vertebra, thoracic vertebra 12～lumbar vertebra 5 vertebral bodys, the spinous process of each vertebral body are not easy to take place the hypertrophy regression.
In breast waist section and lower lumbar spine way of escape fixing operation, only need appear zygapophysial joints, and the vertebral plate outer rim of corresponding vertebral body of thoracic vertebra.And in clinical, need the spinal fracture of pedicle of vertebral arch internal fixation and spinal column degenerated illness mainly to concentrate on thoracic vertebra 11～lumbar vertebra 5 sections.
Pedicle of vertebral arch localization method of the present invention; Be for implementing the basic technology scheme that operation provides, need the operator carefully to check the X-ray and the CT sheet of breast lumbar vertebra before the art, on the X-ray sheet; Measurement needs the fixedly transverse diameter and vertical footpath and e angle and f angle of the pedicle of vertebral arch of vertebral body; On the X-ray plain film, make A, B, C, D and E, E1, E2 intersection point then, just can position pedicle nail accurately, make operation technique simpler; Reduce the time and the intraoperative blood loss of operation wound, thereby improved safety, the accuracy of operation and reduced damage the patient.
The present invention is a benchmark with patient's X-ray sheet, and entry point is confirmed in the location on the X-ray sheet, adopts this method, successfully locatees the many cases medical record, lays a good foundation for implementing operation, and the safety of operation and controllability are high, and be practical.
More than disclosedly be merely specific embodiment of the present invention, but the present invention is not limited thereto, any those skilled in the art can think variation, all should drop within protection scope of the present invention.
Claims (1)
1. pedicle nail coordinate location method based on X-ray film, this method serves as the basis, location with the X-ray plain film, it is characterized in that its localization method comprises the steps: on the X-ray plain film
A. measure the transverse diameter and vertical footpath and angle of the pedicle of vertebral arch of vertebral body;
B. be coordinate points with specific anatomical point on thoracic vertebra 12～lumbar vertebra 5, be extend longitudinally line A through the vertebral plate outer rim;
C. be extending transversely line B through the mid point of thoracic vertebra 12～lumbar vertebra 5 adjacent spinous mid point lines;
D. be extend longitudinally line C through line mid point between thoracic vertebra 10～11 zygapophysial jointss;
E. be extending transversely line D through thoracic vertebra 10 spinous process lower edges,
The intersection point of f.A line and B line moves the anchor point that 4～6mm is thoracic vertebra 12～lumbar vertebra 5 outward;
The intersection point of g.C line and D line is the anchor point of thoracic vertebra 11.
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| Application Number | Priority Date | Filing Date | Title |
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| CN2010105480257A CN101972165B (en) | 2010-11-18 | 2010-11-18 | X-ray-film-based method for locating coordinates of pedicle screws |
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| CN2010105480257A CN101972165B (en) | 2010-11-18 | 2010-11-18 | X-ray-film-based method for locating coordinates of pedicle screws |
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| CN101972165A CN101972165A (en) | 2011-02-16 |
| CN101972165B true CN101972165B (en) | 2012-07-04 |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN104794719B (en) * | 2015-04-28 | 2017-06-13 | 泰山医学院 | A kind of longitudinal arch triangle delineation method based on foot side position X-ray film image |
| CN106236256B (en) * | 2015-10-30 | 2018-07-06 | 自贡市第四人民医院 | A kind of production method of personalization Thoracolumbar disk sagittal curvature mould stick |
| CN106037909B (en) * | 2016-05-19 | 2018-06-19 | 汤向阳 | Thoracolumbar disk screw entrance point and angle positioning device |
| CN111000620A (en) * | 2019-12-09 | 2020-04-14 | 南京市第一医院 | Guide template for percutaneous vertebroplasty and manufacturing and resetting method thereof |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0611290B1 (en) * | 1992-09-14 | 1999-07-28 | Lunar Corporation | Device for an automated determination and analysis of bone morphology |
| CN101536929A (en) * | 2009-04-13 | 2009-09-23 | 郑明辉 | Pedicle screw positioning device and positioning method thereof |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO1994006351A1 (en) * | 1991-02-13 | 1994-03-31 | Lunar Corporation | Automated determination and analysis of bone morphology |
| EP1386276A2 (en) * | 2000-09-29 | 2004-02-04 | Koninklijke Philips Electronics N.V. | Method and system for extracting spine frontal geometrical data including vertebra pedicle locations |
| US20100168858A1 (en) * | 2008-12-30 | 2010-07-01 | Mitchell Hardenbrook | Expandable interbody implant and method |
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0611290B1 (en) * | 1992-09-14 | 1999-07-28 | Lunar Corporation | Device for an automated determination and analysis of bone morphology |
| CN101536929A (en) * | 2009-04-13 | 2009-09-23 | 郑明辉 | Pedicle screw positioning device and positioning method thereof |
Non-Patent Citations (1)
| Title |
|---|
| JP特表2004-509722A 2004.04.02 |
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