中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2014年
1期
41-47
,共7页
朱裕成%马军%李涛%王冰%杨春
硃裕成%馬軍%李濤%王冰%楊春
주유성%마군%리도%왕빙%양춘
下颈椎%椎板%侧块%置钉角度%椎弓根螺钉
下頸椎%椎闆%側塊%置釘角度%椎弓根螺釘
하경추%추판%측괴%치정각도%추궁근라정
Subaxial cervical vertebra%Vertebral lamina%Lateral mass%Direction of pedicle screw insertion%Pedicle screw
目的：探讨下颈椎椎板和侧块作为椎弓根置钉角度参考标志的可靠性。方法：完整成人颈椎骨性标本10具，男、女各5具，模拟施行下颈椎椎弓根置钉手术；术前对C3~C7进行螺旋CT扫描多平面重建，确定椎弓根进钉轴，并以椎板和侧块作为椎弓根内倾角和上倾角的参考标志，测量椎弓根进钉轴与同侧椎板的夹角（PL角）及与侧块后表面的夹角（PLM角），术中以相同参考标志和置钉角度置入椎弓根螺钉。术后复查CT并评估椎弓根螺钉置钉的准确率：0级，螺钉完全位于椎弓根内；1级，穿破椎弓根的部分<螺钉直径的25%；2级，螺钉直径的25%~50%穿破椎弓根；3级，螺钉直径>50%穿破椎弓根；2级和3级螺钉为误置。对颈椎标本各节段椎弓根螺钉位置的分级与椎弓根的宽度与高度进行相关性分析。2011年10月~2012年12月，用同样方法对6例患者进行下颈椎椎弓根螺钉置钉手术，评估置钉准确率和并发症情况。结果：10具颈椎标本的下颈椎椎弓根的PL角，C3、C4>C5、C6>C7；PLM角，C3、C4<C5<C6<C7。10具颈椎标本C3~C7共置入椎弓根螺钉100枚，术后CT判断螺钉位置，0级65枚，1级26枚，2级6枚，3级3枚，误置率为9%。误置节段分布：C34枚，C43枚，C51枚，C61枚。椎弓根螺钉位置的分级与椎弓根的宽度呈负相关（r=-0.356，P=0.000），与椎弓根的高度无显著相关性（r=-0.187，P=0.058）。6例下颈椎椎弓根置钉患者共置入椎弓根螺钉34枚，其中0级21枚，1级9枚，2级3枚，3级1枚，椎弓根螺钉误置率11.7%。术后随访14~19个月（平均16.5个月），无椎动脉损伤、内固定松动等并发症，仅1例患者术后遗留上肢神经根性疼痛。结论：下颈椎椎板、侧块可以作为相应椎弓根螺钉置入角度的可靠参考标志；下颈椎椎弓根的置钉角度并不都垂直于同侧椎板和侧块，不同节段椎弓根的置钉角度不同。
目的：探討下頸椎椎闆和側塊作為椎弓根置釘角度參攷標誌的可靠性。方法：完整成人頸椎骨性標本10具，男、女各5具，模擬施行下頸椎椎弓根置釘手術；術前對C3~C7進行螺鏇CT掃描多平麵重建，確定椎弓根進釘軸，併以椎闆和側塊作為椎弓根內傾角和上傾角的參攷標誌，測量椎弓根進釘軸與同側椎闆的夾角（PL角）及與側塊後錶麵的夾角（PLM角），術中以相同參攷標誌和置釘角度置入椎弓根螺釘。術後複查CT併評估椎弓根螺釘置釘的準確率：0級，螺釘完全位于椎弓根內；1級，穿破椎弓根的部分<螺釘直徑的25%；2級，螺釘直徑的25%~50%穿破椎弓根；3級，螺釘直徑>50%穿破椎弓根；2級和3級螺釘為誤置。對頸椎標本各節段椎弓根螺釘位置的分級與椎弓根的寬度與高度進行相關性分析。2011年10月~2012年12月，用同樣方法對6例患者進行下頸椎椎弓根螺釘置釘手術，評估置釘準確率和併髮癥情況。結果：10具頸椎標本的下頸椎椎弓根的PL角，C3、C4>C5、C6>C7；PLM角，C3、C4<C5<C6<C7。10具頸椎標本C3~C7共置入椎弓根螺釘100枚，術後CT判斷螺釘位置，0級65枚，1級26枚，2級6枚，3級3枚，誤置率為9%。誤置節段分佈：C34枚，C43枚，C51枚，C61枚。椎弓根螺釘位置的分級與椎弓根的寬度呈負相關（r=-0.356，P=0.000），與椎弓根的高度無顯著相關性（r=-0.187，P=0.058）。6例下頸椎椎弓根置釘患者共置入椎弓根螺釘34枚，其中0級21枚，1級9枚，2級3枚，3級1枚，椎弓根螺釘誤置率11.7%。術後隨訪14~19箇月（平均16.5箇月），無椎動脈損傷、內固定鬆動等併髮癥，僅1例患者術後遺留上肢神經根性疼痛。結論：下頸椎椎闆、側塊可以作為相應椎弓根螺釘置入角度的可靠參攷標誌；下頸椎椎弓根的置釘角度併不都垂直于同側椎闆和側塊，不同節段椎弓根的置釘角度不同。
목적：탐토하경추추판화측괴작위추궁근치정각도삼고표지적가고성。방법：완정성인경추골성표본10구，남、녀각5구，모의시행하경추추궁근치정수술；술전대C3~C7진행라선CT소묘다평면중건，학정추궁근진정축，병이추판화측괴작위추궁근내경각화상경각적삼고표지，측량추궁근진정축여동측추판적협각（PL각）급여측괴후표면적협각（PLM각），술중이상동삼고표지화치정각도치입추궁근라정。술후복사CT병평고추궁근라정치정적준학솔：0급，라정완전위우추궁근내；1급，천파추궁근적부분<라정직경적25%；2급，라정직경적25%~50%천파추궁근；3급，라정직경>50%천파추궁근；2급화3급라정위오치。대경추표본각절단추궁근라정위치적분급여추궁근적관도여고도진행상관성분석。2011년10월~2012년12월，용동양방법대6례환자진행하경추추궁근라정치정수술，평고치정준학솔화병발증정황。결과：10구경추표본적하경추추궁근적PL각，C3、C4>C5、C6>C7；PLM각，C3、C4<C5<C6<C7。10구경추표본C3~C7공치입추궁근라정100매，술후CT판단라정위치，0급65매，1급26매，2급6매，3급3매，오치솔위9%。오치절단분포：C34매，C43매，C51매，C61매。추궁근라정위치적분급여추궁근적관도정부상관（r=-0.356，P=0.000），여추궁근적고도무현저상관성（r=-0.187，P=0.058）。6례하경추추궁근치정환자공치입추궁근라정34매，기중0급21매，1급9매，2급3매，3급1매，추궁근라정오치솔11.7%。술후수방14~19개월（평균16.5개월），무추동맥손상、내고정송동등병발증，부1례환자술후유류상지신경근성동통。결론：하경추추판、측괴가이작위상응추궁근라정치입각도적가고삼고표지；하경추추궁근적치정각도병불도수직우동측추판화측괴，불동절단추궁근적치정각도불동。
Objectives: To explore reliability of subaxial vertebral lamina and lateral mass as anatomic land-mark for the orientation of pedicle screw insertion. Methods: Pedicle screws were inserted into C3-C7 pedi-cles on 10 adult cervical vertebral specimens(5 males and 5 females). Vertebral lamina and lateral mass was regarded as anatomic landmark defined as transverse and sagittal angle of pedicle screw insertion respectively. Pedicle-lamina angle (PL angle, the transverse angle) between the central axis of each pedicle and vertebral lamina, and pedicle-lateral mass angle (PLM angle, the sagittal angle) between the central axis and lateral mass were measured preoperatively on computed tomography(CT) images. On the postoperative CT, the grade of pedicle perforation was analyzed(Grade 0 was defined when the entire screw was placed within the cortical bone of the pedicle, grade 1 was defined as less than 25% of the screw diameter violation, grade 2 was de-fined as 25% to 50% of the screw diameter violation, and grade 3 was defined as more than 50% of the screw diameter violation). Grade 0 and 1 were considered to be the correct position, whereas grade 2 and 3 were considered to be wrong positions. Correlative analysis between the grade of each pedicle screw position and the pedicle width or height was performed. From October 2011 to December 2012, 6 patients underwent pedicle screw insertion on subaxial cervical vertebra. Complications and accuracy of pedicle screw placement were evaluated. Results: Among 10 cervical spine specimens, PL angles of C3-C7 pedicles on axial CT im-ages were C3, C4>C5, C6>C7. PLM angles of C3-C7 pedicles on sagittal CT images were C3, C4<C5<C6<C7. 100 cortical screws were inserted into C3-C7 pedicles of 10 human specimens. Postoperative CT scan was performed for the evaluation of pedicle screw position, 65 screws were in grade 0, 26 screws were in grade 1, 6 screws were in grade 2, and 3 screws were in grade 3. The rate of the screw misplacement was 9%. Among 9 screws misplaced, there were 4 screws in C3, 3 screws in C4, 1 screw in C5, 1 screw in C6. Negative correlation was found between the grade of pedicle screw position and pedicle width (r=-0.356, P=0.000). There was no significant correlation between the grade and the pedicle height(r=-0.187, P=0.058). 34 pedicle screws were inserted into C3-C7 pedicles of 6 patients. 21 screws were in grade 0, 9 screws in grade 1, 3 screws in grade 2 and 1 screw in grade 3. The rate of pedicle screw misplacement was 11.7%(4 of 34 screws). All patients were followed up for an average of 16.5 months (ranged from 14 to 19 months). Complications such as screw loosening and vertebral artery injury were not found. Radicular pain on one up-per limb was found in 1 patient . Conclusions: Subaxial vertebral lamina and lateral mass is a reliable anatomic landmark for orientation of pedicle screw insertion. The direction of screw insertion is not always vertical to the ipsilateral lamina or lateral mass. The PL and PLM angle of the pedicle screw placement varies from different levels.
