摘要
目的:研究第一骶后孔和骶外侧嵴与S2椎弓根的位置关系,建立以第一骶后孔和骶外侧嵴为解剖标志的S2椎弓根置钉定位技术。方法:取15具成人干燥骶骨标本,分别从S1、S2和S2、S3椎体融合遗迹(骶横线)处平行骶骨底平面截断骶骨,观察S2椎弓根的形态及第一骶后孔与椎弓根的关系;在平分S2椎弓根处平行骶骨底平面截断骶骨,观察S2椎弓根及其与骶外侧嵴的关系。在S2椎弓根前部(即盆面),平行骶骨底平分椎弓根的平面与骶前孔内侧缘连线的交点为a点,与正中矢状面的交点为b点。测量骶外侧嵴(s点)与a、b两点连线即sa线、sb线与正中矢状面夹角A角、B角及sa、sb的长度(sa和sb分别代表螺钉最小和最大长度,A角和B角分别代表螺钉在水平面上与正中矢状面的最小和最大夹角)。从椎管最外侧的一点P向sa线及sb线引垂线,与sa及sb的交点分别为h1和h2,测量Ph1和Ph2(螺钉最大半径)的长度。第一骶后孔下缘最低点(W)与第二骶后孔上缘最高点(Y)连线为WY,平分椎弓根的平面与WY线的交点为O(螺钉在骶骨后方进钉点),测量WO的距离,O点在W的下方时为正值,O点在W的上方时为负值。在10具成人尸体标本上观察骶骨前血管神经的毗邻关系,并按照上述的测量结果置入S2椎弓根螺钉,使螺钉穿出骶骨前方,观察螺钉的出钉点的位置。结果:S2椎弓根从后外走向前内,呈扇形,后宽前窄。WO的距离为0±1.42mm,椎弓根的中轴平面通过第一骶后孔下缘最低点W,经过两侧W点画一水平线,此线与两侧骶外侧嵴的交点可作为S2椎弓根置钉的进钉点,其进钉角度在矢状面上与骶骨底平行。A角平均为30.23°(27°～33°),B角平均为45.73°(40°～51°);sa平均为27.53mm(26.60～28.14mm),sb平均为35.46mm(34.84～36.04mm);Ph1平均为9.55mm(3.98～5.20mm),Ph2平均为4.53mm(3.94～5.10mm)。螺钉在水平面上与正中失状面夹角应为30.23°～45.73°;螺钉的长度为27.53
Objective：To explore the relationship between the 2nd sacrum pedicle and the first posterior sacral foramen and to establish anatomic landmark and technique of 2nd sacrum pedicle screw placement based on the first posterior sacral foramen and lateral sacral crest.Method：15 dry sacrum specimens from human being were used and the sacrum segments between S1 and S2,S2 and S3 vestige were separated with the line paralleling to plane of sacrum bottom.Sacrum 2 pedicle shape and there surrounding structure were observed.Sacrum 2 pedicle was cut from the midline paralleling to the bottom of sacrum.The relations between pedicle and first posterior sacral foramen,lateral sacral crest were investigated.In the anterior edge of S2 vertebral pedicle（pelvic surface of sacrum）,the intersection of cutting plane with medial marginal line of anterior foramen was defined as point a,the sagittal plane＇s center was point b,and the lateral sacral crest point was s,the length of sa and sb were measured,the for...更多mer represented the screw smallest length and the latter represented the maximum length.The angle between sa and sb at sagittal plane were defined as A and B respectively,A and B representing the smallest and biggest inclined angle in the horizontal plane respectively.The perpendicular line from neurocanal most lateral（point P）to the sa line and sb line were defined as h1 and h2 respectively,the length of Ph1 and Ph2 were measured,the diameter of screw smaller than 2 times of Ph2 lengths was regarded as safe.The line from the first posterior foramen lower end（W）to the second posterior foramen upper end（Y）was obtained.The intersection of equal division of S2 pedicle plane and the WY line was O,WO was measured.10 cadavers＇ sacral anterior structure were observed,pedicle screws placement in 2nd sacrum was performed based on data acquired.Result：The S2 pedicle was fan-shaped,going from posterolaterally to anteromedially.The central axis plane of pedicle was rightly through the lowest point of the S1 po
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2010年第2期152-155,共4页
Chinese Journal of Spine and Spinal Cord
关键词
S2
椎弓根
螺钉
解剖
Sacrum 2
Pedicle
Screw
Anatomic
