摘要
目的 研究横突根部入路经皮椎弓根螺钉内固定技术的解剖学基础,分析该置钉方法可行性.方法 整理100例成人腰椎三维CT图像,在PACS系统测量L1～5置钉横断面置钉内倾角度,椎弓根宽度,理想钉道长度,椎弓根内理想钉道长度.结果 各椎节指标侧别差异无统计学意义(P＞0.05),不同性别角度指标差异无统计学意义(P＞0.05),不同性别大部分长度指标差异有统计学意义(P＜0.05),且男性大于女性.L1～5最小内倾角平均值分别为:15.40°、16.63°、14.74°、11.82°、6.82°;最大内倾角为:36.22°、38.86°、42.99°、49.05°、54.70°;理想进钉内倾角为:23.67°、24.30°、25.08°、27.10°、29.96°,大于传统进钉点置钉内倾角,且存在20.83°～47.88°的安全范围.置钉所在横断面,L1～5椎弓根的宽度平均值男性分别为:6.82、6.96、8.38、10.31、13.65 mm,女性为:5.39、5.78、7.24、9.09、13.21 mm;理想钉道长度男性为:54.90、55.19、55.75、54.87、56.27 mm,女性为:51.04、51.31、52.68、52.11、54.71 mm;椎弓根内理想钉道长度男性为:20.85、19.87、18.41、15.87、15.02 mm,女性为:20.18、19.02、17.00、15.19、15.05 mm.结论 测量结果表明横突根部入路的特定解剖位置作为椎弓根螺钉进钉点的方法安全可行,为经皮置钉技术进钉点的选择提供新的参考依据.
Abstract
Objective To study the anatomical basis of the percutaneous pedicle screw fixation technique in transverse process root approach and analyze the feasibility of the screw placement method.Methods In this study,3D CT reconstruction images of 100 adult lumbar spine from L,to L5 were analyzed by using the PACS system.The imaging anatomical parameters of the screw cross section,including the insertion angle,width of the pedicle,length of the ideal screw tract and length of the ideal screw tract within the pedicle were measured.Results There was no statistical difference between the left and right sides of the same vertebral level(P＞0.05).Additionally,there was no significant difference in angle measurements between different genders(P＞0.05).However,there were significant differences in most length indicators between genders(P＜0.05),with males having larger measurements compared with females.The minimum inner inclination angles from L,to L5 were as follows:15.40°,16.63°,14.74°,11.82°,and 6.82°,respectively.The maximum inner inclination angles were:36.22°,38.86°,42.99°,49.05°,and 54.70°,respectively.The ideal inclination angles were:23.67°,24.30°,25.08°,27.10°,and 29.96°,respectively,exceeded the internal inclination angle of the traditional insertion point and fell within a safe range of 20.83° to 47.88°.In the cross-section where the screw placed,the average pedicle width from L,to L5 in males was:6.82,6.96,8.38,10.31 and 13.65 mm,while in females it was:5.39,5.78,7.24,9.09 and 13.21 mm.The length of the ideal screw tract in males was:54.90,55.19,55.75,54.87 and 56.27 mm,whereas in females it was:51.04,51.31,52.68,52.11 and 54.71 mm.The length of the ideal screw tract within the pedicle in males was:20.85,19.87,18.41 mm,15.87 and 15.02 mm,while in females it was:20.18,19.02,17.00,15.19 and 15.05 mm.Conclusions The imaging results indicate that the transverse process root approach at a specific anatomical location is a safe and reliable insertion point for pedicle screws.This finding provides new reference for selecting the appropriate insertion point of pedicle screws in percutaneous pedicle screw techniques.
维普
万方数据