CAJ | 학술논문

背景:椎弓根螺钉技术已经广泛运用于各种脊柱外科手术,其一般采用经典的背部正中线手术路入,但近年来发现该手术路入会引起一些并发症. 目的:为棘突顶端定位法微创胸腰段椎弓根螺钉内固定技术提供解剖学基础. 方法:选用5具甲醛固定的正常人胸腰段标本,在放大10倍的解剖显微镜下对胸腰段脊柱后部结构进行逐层解剖,重点观测脊神经后支及其分支、脊柱节段动静脉的后支的来源、走行以及分布规律. 结果与结论:节段动脉主要分为肋间动脉,前支和后支.其后支在椎间孔的上外方绕向后下方,走行于脊神经的下方和下位脊椎上关节突的外方,分为内外两支穿行于腰部深层肌肉.节段静脉后支与同名动脉伴行.微创椎弓根螺钉内固定时,入钉点的安全范围在5 mm左右,连接棒经入钉点内侧置入为佳.说明棘突顶端定位法下的经皮椎弓根螺钉技术由于近似于垂直操作且无侧向牵拉,且从椎弓根中心点(入钉点)内侧插入已预弯的连接棒,损伤脊神经后支和血管的机会较少,是微创脊柱外科手术的一种重要技术手段.
배경:추궁근라정기술이경엄범운용우각충척주외과수술,기일반채용경전적배부정중선수술로입,단근년래발현해수술로입회인기일사병발증. 목적:위극돌정단정위법미창흉요단추궁근라정내고정기술제공해부학기출. 방법:선용5구갑철고정적정상인흉요단표본,재방대10배적해부현미경하대흉요단척주후부결구진행축층해부,중점관측척신경후지급기분지、척주절단동정맥적후지적래원、주행이급분포규률. 결과여결론:절단동맥주요분위륵간동맥,전지화후지.기후지재추간공적상외방요향후하방,주행우척신경적하방화하위척추상관절돌적외방,분위내외량지천행우요부심층기육.절단정맥후지여동명동맥반행.미창추궁근라정내고정시,입정점적안전범위재5 mm좌우,련접봉경입정점내측치입위가.설명극돌정단정위법하적경피추궁근라정기술유우근사우수직조작차무측향견랍,차종추궁근중심점(입정점)내측삽입이예만적련접봉,손상척신경후지화혈관적궤회교소,시미창척주외과수술적일충중요기술수단.
BACKGROUND:Pedicle screw technology has been widely used in a variety of spinal surgeries, and it general y uses the classic back midline surgical approach. But in recent years, studies have found that some complications wil be caused by this surgical approach. @@@@OBJECTIVE:To provide the anatomical basis for minimal y invasive spinal surgery under the localization method through spinal process peak. @@@@METHODS:Five formalin-fixed normal human thoracolumbar specimens were selected, and the rear structure of thoracolumbar spine was anatomize layer by layer under anatomical microscope magnified for 10 times, especial y the origin, branch and distribution of the branch and posterior ramus of spinal nerves and the dorsal branches of the segmental artery and vein. @@@@RESULTS AND CONCLUSION:The segmental arteries were mainly divided into the intercostals artery, anterior branch and posterior branch. The posterior branch emerged from the intervertebral foramen posterior to the superior articular process of the vertebral below and divided into their terminal medial and lateral branches. The dorsal branches of the segmental veins paral eled with their corresponding arteries. When the minimal y invasive pedical screw internal fixation would be performed, the safe range of the enter point was about 5 mm, and inserting the connective bar through the inner side of the enter point is safest. The percutaneous pedical screw under the location method of spine process peak is approximately in the vertical operation without lateral traction;inserting the connective bar from inner side wil reduce the chances of posterior branch and blood vessel damage, which is an important technology for minimal y invasive spine surgery.