CAJ | 학술논문

目的探讨腰骶移行椎椎弓根螺钉的进钉方法,为临床应用提供形态学依据.方法共91具腰骶移行椎标本.生前资料完整者59具,男54具,女5具;平均年龄(41.2±16.7)岁,身高(162.4±7.3)cm.对椎弓根、上关节突、人字嵴、横突后部突起及"V"形槽进行观测,确定进钉点、进钉角度及深度.结果按照Castellvi分型法,移行椎ⅡA型13具(左6具,右7具),ⅡB型10具.ⅢA型7具(左2具,右5具).ⅢB型60具,Ⅳ型1具.移行椎人字嵴均不明显,横突后结节突起与上关节突形成的"V"形槽均较明显.以移行椎上关节突关节面下缘水平线与"V"形槽最凹陷处交点作为移行椎椎弓根螺钉的进钉点,该点至椎弓根上缘距离,左(8.6±1.2)mm,右(8.3±1.2)mm;与矢状面呈20°时钉道至侧隐窝外侧壁距离,左(7.5±3.1)mm,右(7.2±2.7)mm;进钉角度,左21.3°±4.1°,右21.0°±4.6°;进钉深度,左(39.1±2.8)mm,右(39.1+2.7)mm.结论腰骶移行椎后部横突变异,人字嵴结构不明显,以此作为进钉定位标志不可靠,而"V"形槽恒定存在,可以将上关节突关节面下缘的水平线与"V"形槽的最凹陷处的交点作为椎弓根螺钉的进钉点.
목적 탐토요저이행추추궁근라정적진정방법,위림상응용제공형태학의거.방법 공91구요저이행추표본.생전자료완정자59구,남54구,녀5구;평균년령(41.2±16.7)세,신고(162.4±7.3)cm.대추궁근、상관절돌、인자척、횡돌후부돌기급"V"형조진행관측,학정진정점、진정각도급심도.결과 안조Castellvi분형법,이행추ⅡA형13구(좌6구,우7구),ⅡB형10구.ⅢA형7구(좌2구,우5구).ⅢB형60구,Ⅳ형1구.이행추인자척균불명현,횡돌후결절돌기여상관절돌형성적"V"형조균교명현.이이행추상관절돌관절면하연수평선여"V"형조최요함처교점작위이행추추궁근라정적진정점,해점지추궁근상연거리,좌(8.6±1.2)mm,우(8.3±1.2)mm;여시상면정20°시정도지측은와외측벽거리,좌(7.5±3.1)mm,우(7.2±2.7)mm;진정각도,좌21.3°±4.1°,우21.0°±4.6°;진정심도,좌(39.1±2.8)mm,우(39.1+2.7)mm.결론 요저이행추후부횡돌변이,인자척결구불명현,이차작위진정정위표지불가고,이"V"형조항정존재,가이장상관절돌관절면하연적수평선여"V"형조적최요함처적교점작위추궁근라정적진정점.
Objective To study the anatomical basis for pedicle screw insertion of the lumbosacral transitional vertebrae.Methods Ninty-one dry lumbosacral transitional vertebrae specimen were anatomical evaluated, and 59 cases of all had intact material in birth (54 males, 5 females), with an average age of (41.2±16.7) years, and an average height of (162.4±7.3) cm.The position of the "V" shape incisure and its relationship with the superior incisure of the pedicle were measured.The distance between the lateral wall of its recess and pedicle screw, the depth of the pedicle screw and the lateral obliquity angle for the pedicle screw insertion were also done.Results According to Castellvi classification, there were 13 lumbosacral transitional vertebrae for ⅡA (left 6, right 7), 10 cases for ⅡB, 7 cases for ⅢA(left 2, right 5), 60 cases for ⅢB, 1 case for IV.The "A" shape crest were observed unclearly in all specimen, but the "V" shape incisure between the posterior eminence of the transverse process and the superior articular process were all observed obviously.The intersection point of lines through the lowest position of the "V" shape incisure and the inferior border of articular cartilage of superior articular process acted as the pedicle screw insertion point of the lumbosacral transitional vertebrae.The distance from the insertion point to the superior incisure of the pedicle was (8.6±1.2) mm in left, (8.3±1.2) mm in right.The distance between the lateral wall of its recess and pedicle screw was (7.5±3.1) mm in left, (7.2±2.7) mm in right when the lateral obliquely angle at the insertion point was 20°.The lateral obliquely angle at the insertion point was 21.3°±4.1° in left, 21.0°± 4.6° in right.The depth of the pedicle screw was (39.1±2.8) mm in left, (39.1±2.7) mm in right.Conclusion Usage a new landmark of the "V" shape incisures for pedicle screw insertion through posterior approach can result in a very simple, easily way that leads to a very high success rate of pedicle screw insertion and a relatively low risk of neurological damage.