新型防神经根损伤双螺纹椎弓根螺钉解剖学依据

doi:10.13418/j.issn.1001-165x.2021.05.002

摘要/Abstract

摘要： 目的　通过测量正常人双侧的胸椎及腰椎椎体解剖学参数，为新型防神经根损伤双螺纹椎弓根螺钉的设计提供理论依据。方法　纳入200例健康志愿者，在仰卧位CT片上测量胸椎T1~12及腰椎L1~5椎弓根螺钉进钉路径的分段长度（椎体段、椎弓根段和椎板段）、进钉外展角及椎弓根峡部宽度和高度。计算各解剖参数的均值和标准差。结果　纳入胸椎志愿者100人，平均年龄31.21岁，腰椎志愿者100人，平均年龄31.05岁。胸椎组螺钉椎体段长度为左侧（19.09±2.36）mm，右侧（19.77±2.54）mm；螺钉椎弓根段长度为左侧（7.67±1.19）mm，右侧（8.17±1.16）mm；螺钉椎板段长度为左侧（9.94±2.02）mm，右侧（9.06±1.71）mm；进钉外展角为左侧（8.61± 2.57）°，右侧（8.44±2.71）°；椎弓根峡部宽度为左侧（8.44 ± 2.71）mm，右侧（5.95 ± 1.16）mm；椎弓根峡部高度为左侧（11.76±1.86）mm，右侧（11.79±2.24）mm。腰椎组螺钉椎体段长度为左侧（26.99 ± 3.37）mm，右侧（27.06±3.24）mm；椎弓根段长度为左侧（10.00±1.58）mm，右侧（10.37 ± 1.53）mm；椎板段长度为左侧（12.74±2.16）mm，右侧（13.96±2.46）mm；进钉外展角为左侧（16.16±2.93）°，右侧（16.31±3.05）°；椎弓根峡部宽度为左侧（9.72±1.59）mm，右侧（9.45±1.84）mm；椎弓根峡部高度为左侧（14.50±2.83）mm，右侧（14.05±2.39）mm，胸椎与腰椎螺钉椎体段长度、椎弓根段长度、椎板段长度、进钉外展角各参数对比，差异无统计学意义（P>0.05），T1~L5椎弓根峡部高度分别与椎弓根峡部宽度比较，有统计学差异（P<0.05）。结论　通过对正常人群胸椎及腰椎椎骨较为细致的相关解剖学测量，可获得设计新型双螺纹椎弓根螺钉的较准确依据。

关键词: 胸椎； , , 腰椎； , , 解剖学测量； , , 新型双螺纹椎弓根螺钉

Abstract: Objective　To provide the anatomical basis of a new double- threaded pedicle screw for reducing the incidence of nerve root injury, by measuring the anatomical parameters of thoracic and lumbar vertebrae.　Methods　Two hundred healthy volunteers were included for the thoracic and lumbar spine CT scan. The following parameters were measured on CT films: the segment lengths of pedicle screw entry path (the length of the vertebral body, the pedicle and the lamina), the height of the pedicle isthmus, the pedicle isthmus and the angle of the screw abduction. The mean and standard deviation of each parameter were calculated.　Results　A total of 100 thoracic volunteers with an average age of 31.21 years old and 100 lumbar volunteers with an average age of 31.05 years old were included. Parameters of the thoracic group were as follows: the length of the vertebral body was left (19.09±2.36)mm, right (19.77±2.54) mm, the length of the pedicle was left (7.67±1.19)mm, right (8.17±1.16)mm, the length of the lamina was left (9.94±2.02)mm, right (9.06±1.71)mm, the height of the pedicle isthmus was left (11.76±1.86)mm, right (11.79±2.24)mm, the width of the pedicle isthmus was left (8.44±2.71)mm, right (5.95±1.16)mm, the angle of the screw abduction was left (8.61±2.57)°, right (8.44±2.71)°. Parameters of the lumber group were as follows: the length of the vertebral body was left (26.99±3.37)mm, right (27.06±3.24)mm, the length of the pedicle was left (10.00±1.58)mm, right (10.37±1.53)mm, the length of the lamina was left (12.74±2.16)mm, right (13.96±2.46)mm, the height of the pedicle isthmus was left (14.50±2.83)mm, right (14.05±2.39)mm, the width of the pedicle isthmus was left (9.72±1.59)mm, right (9.45±1.8)mm, the angle of the screw abduction was left(16.16±2.93)°, right (16.31±3.05)°.There was no statistical differences on the length of the vertebral body, pedicle, lamina and the angle of the screw abduction between the thoracic and the lumbar groups at the same segment (P>0.05).There were statistical differences on the pedicle isthmus height from T1 to L5 and pedicle isthmus width between the two groups (P<0.05).　Conclusions　Detailed anatomical measurements of the thoracic and lumbar vertebrae in healthy subjects can provide more accurate basis for the design of a new double-threaded pedicle screw.

Key words: Thoracic vertebra, 　Lumbar vertebra, 　Anatomical measurement, 　Double-threaded pedicle screw

中图分类号:

R322

肖忠洲, 刘家明, 黄山虎, 刘志礼. 新型防神经根损伤双螺纹椎弓根螺钉解剖学依据[J]. 中国临床解剖学杂志, 2021, 39(5): 507-512.

Xiao Zhongzhou, Liu Jiaming, Huang Shanhu, Liu Zhili. Anatomical basis of a new double-threaded pedicle screw for preventing nerve root injury[J]. Chinese Journal of Clinical Anatomy, 2021, 39(5): 507-512.

参考文献 24

[1]	Skinner R, Maybee J, Transfeldt E, et al. Experimental pullout testing and comparison of variables in tranpedicular screw fixation. A biomechanical study[J]. Spine (Phila Pa 1976), 1990, 15(3): 195-201. DOI: 10.1097/00007632-199003000-00007.
[2]	Mehta H, Santos E, Ledonioetal C, et al. Biomechanical analysis of pedicle screw thread differential design in an osteoporotic cadaver model[J]. Clin Biomech(Bristol Avon), 2012, 27(3): 234-240. DOI: 10.1016/j.clinbiomech.2011.10.004.
[3]	Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients[J]. J Eurosurg Spine, 2012, 16(3): 238-247. DOI: 10.3171/2011.11.SPINE11102.
[4]	Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review[J]. Spine, 2010, 35(11): E465-E470. DOI: 10.1097/BRS.0b013e3181d1021a.
[5]	乔拴杰, 韩西城. 胸椎椎弓根的形态测量及其临床意义[J]. 中国临床解剖学杂志, 1996, 14(3): 193-195. DOI: 10.13418/j.issn.1001-165x.1996. 03. 016.
[6]	Attar A, Ugur HC, Uz A, et al. Lumbar pedicle: surgical anatomic evaluation and relationships[J]. Eur Spine J, 2001, 10(1): 10-15. DOI: 10.1007/s005860000198.
[7]	史亚民, 柴伟, 侯树勋, 等. 胸椎椎弓根形态测量研究[J]. 中国脊柱脊髓杂志, 2002, 12(3): 191-193. DOI: 10.3969/j.issn.1004-406X. 2002. 03.018.
[8]	陈茂林, 尹维刚, 姚乃中, 等. 下位胸椎和腰椎椎弓根固定术的应用解剖[J]. 中国临床解剖学杂志, 1994, 12(4): 298-300. DOI: 10.13418/j.issn.1001-165x1994.04.031.
[9]	Roy-Camille R, Saillant GR, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating[J]. Clin Orthop Relat Res, 1986, 203：7-17. DOI: 10.1097/00003086-198602000-00003.
[10]	杨述华, 胡勇. 脊柱椎弓根螺钉系统的特点和应用[J]. 中国骨伤, 2002, 15(7): 442-444. DOI: 10.3969/j.issn.1003-0034.2002.07.045.
[11]	Chao KH, Lai YS, Chen WC, et al. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens[J]. Med Eng Phys, 2013, 35(10): 1506-1512. DOI: 10.1016/j.medengphy.2013.04.007.
[12]	陈家强, 周立兵, 余明华, 等. 胸腰椎椎弓根的解剖学测量及其临床意义[J]. 解剖学研究, 2004, 26(1): 63-65. DOI: 10.3969/j.issn.1671-0770.2004.01.023.
[13]	王方永, 李建军. 胸腰椎椎弓根解剖参数三维分析[J]. 中国康复理论与实践, 2012, 18(2): 134-136. DOI: 10.3969/j.issn.1006-9771. 2012. 02.012.
[14]	阮狄克, 沈根标, 方津生, 等. 100例国人腰椎弓根的CT测量及其临床意义[J]. 中国脊柱脊髓杂志, 1993, 3(6): 244-247. DOI: CNKI: SUN:ZJZS.0.1993-06-002.
[15]	Magerl FP. Stabilization of the lower Thoracic and lumbar spine with external skeletal fixation[J]. Clin Orthop Relat Res, 1984, 189: 125-141. DOI: 10.1007/BF00436142.
[16]	Müller ME, Allgower M, Schneider R. Manual of internal fixation, 2nd ed[M]. New York: Springer, 1979: 282-295. DOI: 10.1007/978-3-642-77380-8.
[17]	Esses SI, Sachs BL, Dreyzin V. Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members[J]. Spine (Phila Pa 1976), 1993, 18(15): 2231-2238. DOI: 10.1097/00007632-199311000-00015.
[18]	Louis R. Fusion of the lumbar and sacral spine by internal fixation with screw plates[J]. Clin Orthop Relat Res, 1986, 203: 18-33. DOI: 10.1097/00003086-198602000-00004.
[19]	Matsuzaki H, Tokuhashi Y, Matsumoto F, et al. Problems and solutions of pedicle screw plate fixation of lumbar spine[J]. Spine (Phila Pa 1976), 1990, 15(11): 1159-1165. DOI: 10.1097/00007632-199011010-00014.
[20]	杨科球, 熊翔密, 漆光平, 等. 椎弓根的解剖学观测与临床意义[J]. 解剖学研究, 1999, 21(1): 12-13. DOI: CNKI: SUN:GDJP.0.1999-01-005.
[21]	Moran JM, Berg WS, Berry JL, et al. Transpedicular screw fixation[J]. J Orthop Res, 1989, 7(1): 107-114. DOI: 10.1002/jor.1100070115.
[22]	Misenhimer GR, Peek RD, Wiltse LL, et al. Anatomic analysis of pedicle cortical and cancellous diameter as related to screw size[J]. Spine (Phila Pa 1976), 1989, 14(4): 367-372. DOI: 10.1097/00007632-198904000-00004.
[23]	Christodoulou AG, Apostolou T, Ploumis A, et al. Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population[J]. Clin Anat, 2005, 18(6): 404-408. DOI: 10.1002/ca.20155.
[24]	林炎生, 周庭永, 韩景茹, 等. 下位腰椎椎弓根内固定术的断层解剖与CT[J]. 中国临床解剖学杂志, 2002, 20(3): 194-97. DOI: 10.13418/j.issn.1001-165x.2002.03.014.