CAJ | 학술논문

目的明确胸椎后路经关节突关节椎弓根螺钉固定的解剖学可行性和技术参数,为临床应用提供参考.方法取20具胸椎标本,仔细解剖胸椎的后侧和前侧方,以清楚地暴露胸椎椎板和椎弓根.以椎板下缘向上、外缘向内各7 mm为进钉点,在T1,2、T5,6、T9,10直视下置入经关节突关节椎弓根螺钉,通过直接的置钉和CT重建,观察胸椎后路经关节突关节椎弓根螺钉实际置钉的可行性,测量经关节突关节椎弓根螺钉内固定进钉角度和钉道长度.结果所有胸椎后路经关节突关节椎弓根螺钉均由上位胸椎下关节突经关节突关节,进入下位胸椎的椎弓根,成功置入下位胸椎的椎体内.重建CT测量发现螺钉在横断面的外倾角度为2.1°±0.7°,在矢状面的尾倾角度为41.4°±3.2°,在各节段间略有不同,但差异无统计学意义.平均的螺钉钉道长度为(40.6±4.9)mm,钉道长度由上胸椎向中、下胸椎呈逐渐增加趋势,差异有统计学意义(F=74.09,P＜0.01).结论胸椎后路经关节突关节椎弓根螺钉具有解剖学可行性,可以作为胸椎椎弓根螺钉固定的一种补充内固定方法,但置钉时要求较高的准确性.
목적 명학흉추후로경관절돌관절추궁근라정고정적해부학가행성화기술삼수,위림상응용제공삼고.방법 취20구흉추표본,자세해부흉추적후측화전측방,이청초지폭로흉추추판화추궁근.이추판하연향상、외연향내각7 mm위진정점,재T1,2、T5,6、T9,10직시하치입경관절돌관절추궁근라정,통과직접적치정화CT중건,관찰흉추후로경관절돌관절추궁근라정실제치정적가행성,측량경관절돌관절추궁근라정내고정진정각도화정도장도.결과 소유흉추후로경관절돌관절추궁근라정균유상위흉추하관절돌경관절돌관절,진입하위흉추적추궁근,성공치입하위흉추적추체내.중건CT측량발현라정재횡단면적외경각도위2.1°±0.7°,재시상면적미경각도위41.4°±3.2°,재각절단간략유불동,단차이무통계학의의.평균적라정정도장도위(40.6±4.9)mm,정도장도유상흉추향중、하흉추정축점증가추세,차이유통계학의의(F=74.09,P＜0.01).결론 흉추후로경관절돌관절추궁근라정구유해부학가행성,가이작위흉추추궁근라정고정적일충보충내고정방법,단치정시요구교고적준학성.
Objective To identify the feasibility and the anatomical parameters of posterior transarticular pedicle screw fixation in the thoracic spine, provide a reference for clinical applications. Methods Twenty human cadaveric thoracic spine segments were dissected posteriorly and anteriorly, with care taken to expose the laminas and pedicles. The entrance point of transarticular pedicle screws was located in the 7 mm away from the above at the inferior margin of the lamina and the inside at the exterior margin, respectively. Posterior transarticular pedicle screws implantation was performed under direct visualization into T1,2,T5,6 and T9,10 Under direct abservation, the feasibility of posterior transarticular pedicle screw fixation was assessed. Then a CT was done. On the morphologic CT scan, the angle and length of the transarticular pedicle crew trajectory were measured. Results The thoracic transarticular pedicle screw trajectory were caudal tilting in the sagittal plane and lateral tilting in the axial plane with successful placement. Screws were placed across the facet joint, and from the inferior articular process of upper thoracic vertebra into the pedicle of lower thoracic vertebra. There was little difference between different number of thoracic vertebrae of the angle, but without significance. The average angles of the screws were 41.4°+3.2°caudal tilting in the sagittal plane and 2.1°±0.7° lateral tilting in the axial plane. The average trajectory lengths were (40.6±4.9)mm, and the lengths increased gradually from upper thoracic vertebra to middle and lower. There were significant differences statistically among T1,2, T5,6 and T9.10 (F=74.09, P＜0.01 ). Conclusion Posterior transarticular pedicle screw fixation is feasible, and there are some directions for implantating the screws. Transarticular pedicle fixation in the thoracic spine affords an alternative to standard pedicle screw placement for thoracic stabilization.