CAJ | 학술논문

背景：上胸椎周围结构复杂，椎弓根横径相对较小，椎体前方存在重要组织脏器，螺钉偏离轴线或螺钉过长，置钉的安全性和有效性得不到保障，有必要对其周围重要结构做一了解。目的：分析上胸椎椎弓根螺钉轴线与椎体前重要毗邻结构的解剖位置关系。方法：对30例健康成人志愿者进行T 1-T 4平行椎弓根轴线CT扫描，观察椎弓根螺钉沿椎弓根轴线置入时椎体前方食管、气管、主动脉弓、颈动脉、椎动脉等结构的位置，测量每一椎体两侧椎弓根轴线与这些结构的最短距离。采用配对t检验进行分析。结果与结论：共240个测量参数被分析，T 1-3左侧椎弓根轴线与食管距离小，T2左侧椎弓根最小；T2-4右侧椎弓根轴线与气管距离小；T3，T4右侧椎弓根轴线与右主支气管距离小；颈动脉和椎动脉无损伤的危险性。62%的患者主动脉弓在T4平面，且无损伤危险性。提示左侧椎弓根螺钉易损伤食管，右侧椎弓根易损伤气管，颈动脉、椎动脉和主动脉弓不易损伤。上胸椎椎弓根螺钉置入前仔细分析CT数据可以确定易损伤结构的解剖位置。
배경：상흉추주위결구복잡，추궁근횡경상대교소，추체전방존재중요조직장기，라정편리축선혹라정과장，치정적안전성화유효성득불도보장，유필요대기주위중요결구주일료해。목적：분석상흉추추궁근라정축선여추체전중요비린결구적해부위치관계。방법：대30례건강성인지원자진행T 1-T 4평행추궁근축선CT소묘，관찰추궁근라정연추궁근축선치입시추체전방식관、기관、주동맥궁、경동맥、추동맥등결구적위치，측량매일추체량측추궁근축선여저사결구적최단거리。채용배대t검험진행분석。결과여결론：공240개측량삼수피분석，T 1-3좌측추궁근축선여식관거리소，T2좌측추궁근최소；T2-4우측추궁근축선여기관거리소；T3，T4우측추궁근축선여우주지기관거리소；경동맥화추동맥무손상적위험성。62%적환자주동맥궁재T4평면，차무손상위험성。제시좌측추궁근라정역손상식관，우측추궁근역손상기관，경동맥、추동맥화주동맥궁불역손상。상흉추추궁근라정치입전자세분석CT수거가이학정역손상결구적해부위치。
BACKGROUND:The structure surrounding upper thoracic spine is complicated. Transverse diameter of pedicle was relatively smal . There were important organs in front of the vertebral body. Screws deviated from axis or screws were too long. The safety and effectiveness of screw implantation were not implemented. It is necessary to understand the key structure of surroundings. OBJECTIVE:To analyze the relationship of anatomic position between the axis of screw of pedicle of upper thoracic spine and key adjacent structure of the vertebral body. METHODS:A total of 30 healthy adult volunteers received T 1-T 4 pedicle axis paral el to CT scans. The positions of esophagus, trachea position, aortic arch, carotid and vertebral arteries were observed when the pedicle screw was implanted along the pedicle axis. The shortest distance on both sides of a vertebral pedicle axis from these structures was measured. Paired t-test was utilized for analysis. RESULTS AND CONCLUSION:240 measurement parameters were analyzed. The distance from the left pedicle axis on T 1-3 to esophagus was smal , and the left pedicle on T 2 was minimal. The distance from the right pedicle axis on T 2-4 to trachea was smal . The distance from right pedicle axis on T 3 , T 4 to right main bronchus was smal . Carotid and vertebral artery did not show the risk of injury. 62%of the patients were in the aortic arch on T 4 plane, and no risk of damage was found. These results indicated that the left pedicle screws were easy to damage the esophagus, and the right pedicle screw was easy to damage trachea. Carotid artery, vertebral artery and aortic arch were not easy to be damaged. The anatomic position of easily damaged structure could be identified by careful analysis of CT data before screw implantation in the pedicle of upper thoracic spine.