3D reconstruction of anterior vertebral blood vessels for bi-cortical lumbar pedicle screws fixation
CHEN Li-Bang, CHEN Chun
Chinese Journal of Clinical Anatomy ›› 2013, Vol. 31 ›› Issue (5) : 528-531.
3D reconstruction of anterior vertebral blood vessels for bi-cortical lumbar pedicle screws fixation
Objective The reconstruction and measurement of the anterior large blood vessels of lumbar vertebral based on CT and 3-D reconstruction for feasibility and safety of bi-cortical pedicle screw fixation. Methods 10 fresh adult specimens with gelatin-lead oxide suspension infusion were scaned using multi-CT in order to observe the vessels for measuring the point between pedicle axis line and anterior vertebral edge. L/RAD (L/RVD) refers to the distance from the junction point between pedicle axis line and anterior vertebral edge to the abdominal aorta (inferior vena cava or iliac vein). Results There was statistical difference between both sides of AD of vertebrae (L1~3) and VD of vertebrae (L3~5). The abdominal aorta has a tendency to approach close to the anterior aspect of L1~3 vertebrae (0.38~0.46 cm), but not to L3~5 (0.46~0.16 cm). The inferior vena cava was far away the anterior aspect of vertebrae of L1~4 (1.00~0.11 cm). At L1~4 pedicle planes, abdominal aorta located in the -6°~30° area of the front of vertebrae．At L1~3 pedicle planes，inferior vena cava was located in -15°~57° area and -10°~60° for L4．Iliac artery (inside and outside) of left and right anterior border of L5 located in 4°~10°, -20°~60°, -18°~35°, -50°~70°. Conclusion In L1~5, it is quite possible to injure abdominal aorta if the left pedicle screws were over deeply planted. Screws plantation in right L1~3 is easy. When planning the screws in right pedicles of L4 and L5, caution should be taken to avoid injury to iliac artery.
Great vessels / Three-dimensional reconstruction / Amira software / Bi-cortical pedicle screw fixation
[1] Yang SC, Chen HS, Kao YH, et al. Percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fracture adjacent to lumbar instrumented circumferential fusion
[J]. Orthopedics,2012, 35(7):e1079-1085.
[2] Yang SC, Chen HS, Kao YH, et al. Clinical evaluation of percutaneous vertebroplasty for symptomatic adjacent vertebral compression fracture
[J].J Spinal Disord Tech, 2013,26(4):E130-136.
[3] Kim HS, Kim SH, Ju CI, et al. The role of bone cement augmentation in the treatment of chronic symptomatic osteoporotic compression fracture
[J]. J Korean Neuro Soci, 2010, 48(6):490-495.
[4] Kim KH, Lee SH, Lee DY, et al. Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis
[J]. J Neurosurg Spine, 2010,12(5):525-532.
[5] 刘列华,兰阳军,周强,等. 腰椎椎弓根螺钉双皮质固定的椎前大血管解剖学研究
[J].局解手术学杂志, 2012, 21(6):593-595.
[6] 杨卫良,祁全,陆晓峰,等.椎弓根钉“双皮质”固定技术治疗老年人腰椎滑脱及腰椎失稳症
[J]. 中国组织工程研究与临床康复, 2009, 13(48):9526-9530.
[7] 张志浩,李严斌,梅劲,等. 应用放射造影术进行血管3D可视化研究初探
[J]. 中国临床解剖学杂志, 2006, 24(2):255-258.
[8] 徐凯, 陈春, 黄山东, 等. 腰椎椎弓根螺钉内固定术三维可视化设计
[J]. 解放军医学杂志, 2011, 36(9)935-938.
[9] Goel VK, Grauer JN, Patel T, et al. Effects of charite artificial disc on the implanted and adjacent spinal segments mechanics using a hybrid testing protocol
[J]. Spine, 2005, 30(24):2755-2764.
[10]Bowden AE, Guerin HL, Villarraga ML, et al. Quality of motion considerations in numerical analysis of motion restoring implants of the spine
[J]. Clin biomech, 2008, 23(5):536-544.
[11] Liu D, Wu ZX, Pan XM, et al. Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate- augmented pedicle screw
[J]. Arch Orthop Trauma Surg, 2011, 131(9):1227-1232.
[12] Yi X, Wang Y, Lu H,et al. Augmentation of pedicle screw fixation strength using an injectable calcium sulfate cement: an in vivo study
[J]. Spine, 2008, 33(23):2503-2509.
[13] Aydogan M, Ozturk C, KaratoprakO, et al. The pedicle screw fixation with vertebroplasty augmentation in the surgical treatment of the severe osteoporotic spines
[J]. J Spinal Disord Tech, 2009,22(6):444-447.
[14]Abdul-Jalil Y, Bartels J, Alberti O, et al. Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty
[J]. Spine, 2007, 32(20):E589-593.
[15] Stricker K, Orler R, Yen K, et al. Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty
[J]. Anesanalg, 2004, 98(4):1184-1186.
[16] Freitag M, Gottschalk A, Schuster M, et al. Pulmonary embolism caused by polymethylmethacrylate during percutaneous vertebroplasty in orthopaedic surgery
[J]. Actaanaesth Scand, 2006, 50(2):248-251.
[17] 鞠洪斌, 覃健, 郭东明,等. 骨水泥量对椎体成形术疗效和渗漏并发症的影响
[J]. 中国现代手术学杂志, 2012, 16(1)38-41.
[18] 王景续. 采用椎弓根钉“双皮质”固定治疗老年骨质疏松性椎体骨折的近期疗效观察
[J]. 中国矫形外科杂志, 2011, 19(22):1863-1865.
[19] Yi XD, Lu HL, Gong SY. Effect of pedicle screw fixation with bone cement in lumbar
[J]. Zhonghua waike zazhi, 2004, 42(23):1427-1429.
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