摘要
目的探讨胸椎椎弓根根外内固定的手术路径,并对其进行解剖学研究,为胸椎后路内固定提供更为安全可靠的方式,以避免胸椎椎弓根手术的危险并发症。方法对60个正常成人的T1～10节段的CT扫描图像进行放射解剖学研究,测量改良肋横突入路、横突入路、椎弓根入路三种入路的长度、宽度、内倾角度,对测量数据进行统计学分析并比较三种入路各参数的差异;根据测量结果设置各入路穿钉参数并在5具尸体上进行手术模拟,穿钉后用肉眼观测及CT扫描,评价置钉准确性。结果各测量参数三种入路间差异有统计学意义(P<0.05);改良肋横突入路长度最长,横突入路次之,椎弓根入路最短;改良肋横突及横突入路具有相同宽度,椎弓根入路最窄,与前两种入路比较差异有统计学意义(P<0.01);内倾角度改良肋横突入路最大,横突入路次之,椎弓根入路最小,各入路至椎体前外1/3点与至椎体前中点的长度及角度差异有统计学意义(P<0.01或0.05);根据测量结果设置了三种入路的穿钉参数并在5具尸体上穿钉成功。结论胸椎椎弓根根外内固定与椎弓根内固定相比具有安全可靠、简单实用等优点,并具有理论上的生物力学优越性,是胸椎后路内固定术的一种良好选择。
Objective To investigate the operation approach to thoracic extrapedicular screw fixation and make an anatomic study so as to offer more safe and reliable operation approaches to thoracic posterior fixation and avoid the dangerous complications of thoracic transpedicular operation. Methods Thoracic （T1-10 ） CT scans of 60 adults were obtained to measure the length, the width, the transverse angle of the modified costotransverse passage, the transverse process passage and the transpedicular passage, which were analyzed statistically and compared. The parameters of the screw insertion passages were determined based on the analytical results and the modeling operation proceeded on five cadavers, when the screw placement was observed by CT and naked eyes postoperatively for evaluation of the accuracy of screw placement. Results There existed significantly statistical difference upon three screw passages （ P 〈 0.05 ） in aspects of length and width, ie, the passage was the longest for the modified costotransverse passage, next for the transverse process passage and the shortest for the transpedicular passage. The costo-transverse passage and the transverse process passage had the same width but the transpedicular passage was the narrowest, with significantly statistical difference （P 〈0.01 ）. The costo-transverse passage had the maximum transverse angle but the transpedicular passage had the minimum transverse angle. In the meantime, statistical difference （P 〈 0.01 or P 〈 0.05 ） was found between the length and angle to the point of anterior and lateral one-third of vertebral body and the length and angle to the point of anterior central point of vertebral body. The screws were penetrated successfully on five cadavers based on the determined parameters. Conclusion Compared to the transpedicular fixation, the extrapedicular fixation is safer and simpler alternative to thoracic posterior fixation because of its theoretical biomechanical superiority.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2005年第10期768-772,共5页
Chinese Journal of Trauma
