椎弓根的测量与力学分析

对３０具男性成人干燥椎骨椎弓根的长、高、厚，体根角及椎弓根间夹角进行了测量。发现椎弓根长自上而下呈缓慢增加趋势；椎弓根高及厚有距重力线较近的椎骨明显增大；体根角的大小与载荷在椎骨前后椎间的传递方向有关；椎弓根间夹角在颈曲最大，胸腰曲移行处最小。结果提示：不同节段椎弓根的有关测量值的差异主要与该节段椎骨距重力线远近、重心高低及脊柱曲度方向有关。     

颈椎后路关节突—椎弓根联合内固定的解剖学基础

对３０例成人干燥椎骨第２￣７颈椎的下关节突厚度、相邻椎骨关节突对合厚度、关节突进钉点与横突孔外侧壁间的角度、椎弓根的长宽高度、椎弓根与椎体矢状面及水平面间的夹角等项指标进行了观测。通过综合分析所得结果，对颈椎后路关节突－椎弓根联合固定的可行性和螺丝钉的选择、进钉方向及深度等进行了讨论。     

腰椎间小关节螺旋CT三维测量、观察及临床意义

目的:观察腰椎间小关节关节面的三维解剖学形态,并探讨其临床意义.方法:60例螺旋CT扫描腰部阴性正常人,行三维重建后处理.在横轴面、冠状面及矢状面观察关节面形态.结果:关节突关节面的标准形态,横轴面,腰1/2节段上、下关节突关节面为曲度相同的"C"形;腰2/3、3/4、4/5节段上、下关节突关节面为曲度不相同的"C"形,下关节突关节面曲度较小,上关节突关节面曲度较大;腰5/骶1节段男性下关节突关节面"l"形,上关节突关节面"C"形,女性上、下关节突关节面均为"l"形.冠状面,腰1/2、2/3节段为椭圆形.腰3/4节段男性为椭圆形;女性为长方形.腰4/5节段男性为椭圆形;女性为椭圆形或长方形.腰5/骶1节段男女均可为圆形;或男性为方形女性为长方形.矢状面,为"l"形.结论:腰椎间小关节关节面形态在诸节段及横轴面、冠状面及男、女间不尽相同.     

椎板侧方入路治疗极外侧腰椎间盘突出症的应用解剖

目的:为后正中经椎板侧方入路手术治疗极外侧腰椎间盘突出症提供显微外科解部学基础。方法:20具经防腐固定的成人尸体标本,观测横突间韧带厚度、前后方血管和腰神经前支走行。结果:横突间韧带厚度0.60～1.39mm;L3～5节段动脉前支及伴行静脉90%以上位于相邻横突间韧带腹侧上1/2处,横突间韧带背侧中1/3处有一恒定节段动脉分支;腰神经前支与矢状面夹角18.9°～39.2°,下位横突的副突处距前方走行腰神经前支距离为5.63～8.05mm,椎弓峡部侧缘至腰神经前支的距离为1.73～3.64mm。结论:横突间韧带是该入路重要的解剖学标志,熟悉其应用解剖对手术治疗极侧腰椎间盘突出症具有重大指导意义。     

颈椎后路钢板内固定的应用解剖学

目的：测量国人下颈椎后部结构的相关径线及角度,为颈椎后路钢板的设计及手术方式提供参考。方法：对３５套正常成人颈椎干燥骨标本（Ｃ３－Ｃ７）进行测量,包括椎弓根宽度、高度、长度、椎投影点位置,椎弓根与椎体的角度、高度、厚度、侧块后壁中心点内容民后壁的距离、与横突孔外壁的夹角以及上关节突关节面的倾有等。结果 ：颈椎椎弓根平均宽度值４．９７￣６．０８ｍｍ,与椎体矢状面平均夹角值３４．３８￣４５．４２℃,与     

胸腰脊神经后根形态计量研究

在15具成人尸体上对胸腰脊神经后根进行了大体解剖和形态计量研究.结果表明:(1)上胸段脊神经后根的囊外段长度、硬膜点横径和脊髓点束数在逐节减少;后根的囊外段与囊长轴之下夹角>90°,囊内段及脊髓点分布长度在逐节增加,交通支最丰富.(2)中胸段脊神经后根的囊外段长度、硬膜点横径和脊髓点束数各节段波动范围较小,下夹角在90°左右,囊内段短,脊髓点分布长.(3)下胸段脊神经后根的脊髓点分布长度转而下降,下夹角<90°,其它指标均逐节增加.(4)腰段脊神经后根的脊髓点分布长度进一步减少,下夹角最小,其它指标达最大值,交通支丰富.根据研究结果进行后根受损危险排序,腰>下胸>上胸>中胸.     

颈椎间关节关节面的形态、面积及其力学分析

在45套(男25,女20)通辽地区出土的干燥成人骨骼标本上,观测了颈椎间关节关节面的形态和面积。颈椎间关节关节面的形态可分为圆型、椭圆型和不规则型,各节段均以椭圆型占优势。各节段下关节突关节面的面积均大于上关节突关节面的面积,但仅颈4～5和颈5～6节段有显著性差异。     

颈前路钩椎关节切除术的应用解剖

目的为临床颈前路钩椎关节切除手术提供应用解剖学基础。方法15套干燥成人颈椎标本,分别测定:①C3-C6横突孔的横、矢径;②钩椎关节与横突孔的间距;③横突孔前壁厚度;④钩椎关节与椎间孔的间距;⑤两侧椎间孔所在平面间夹角。14具成人尸体标本,解剖测定:①C3-C6各节段上下缘椎体正中线与椎动脉的距离;②各横突孔壁内和相邻横突孔间的椎动脉的长度;③椎间孔的横、竖径。结果①C3-C6中,C5的横突孔横径最小;②横突孔前壁厚度由C3-C6逐渐增加;③钩椎关节与横突孔间距在C6处最小;④椎体正中线与椎动脉V2段的距离由C3-C6逐渐增大。结论熟悉局部解剖是避免损伤椎动脉的关键     

不同节段椎弓根钉置入脊椎内固定治疗腰椎滑脱☆

背景：对椎弓峡部裂腰椎滑脱、退行性腰椎滑脱的治疗,到底是采用短节段固定还是长节段固定争论很多。 目的：观察短节段或长节段椎弓根钉内固定治疗腰椎滑脱的临床疗效。 方法：腰椎滑脱患者146例,男36例,女110例,年龄22~73岁,平均53岁,病程1~18年,平均5年。采用腰椎管扩大开窗减压或全椎板切除减压、短节段或长节段椎弓根螺钉复位内固定、横突间或椎体间植骨融合。 结果与结论：146例患者中采用短节段4枚椎弓根螺钉固定72例,长节段6枚椎弓根螺钉固定74例。椎间植骨101例,横突间植骨45例。术后随访134例,随访时间1.5~14年,按Steffee临床疗效分级标准,优74例,良41例,中13例,差6例,优良率85.8%。完全复位77例,其中短节段固定32例,长节段固定45例;部分复位69例,其中短节段固定40例,长节段固定29例。短节段固定者有8例13枚椎弓根螺钉发生断裂,而长节段固定者未发生椎弓根螺钉断裂。分析患者腰椎滑脱的类型、程度、病程长短、是否合并相邻节段椎间盘退变、不稳等情况,是选择用短节段还是用长节段置入固定的依据。     

经皮椎弓根螺钉技术的解剖学基础及其临床意义

目的：为经皮椎弓根螺钉技术提供解剖学基础并在此基础上分析经皮植入椎弓根螺钉较常规开放植入椎弓根螺钉临床应用的优点。方法：选用10具经防腐固定，在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：脊神经后支的内侧支经骨纤维管下行沿途支配横突棘肌，支配下方小关节突、筋膜和韧带。外侧支向外下行走，沿途支配背部深层肌肉。节段动脉的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，并与对侧、相邻节段同名静脉在棘突和横突部位构成静脉丛。结论：避免损伤脊神经后支和节段动静脉的后支并运用可视化操作系统的经皮椎弓根螺钉植入技术，是微创脊柱外科一种新的技术手段。     

Extrinsic risk factors for compromised blood flow in the vertebral artery: anatomical observations of the transverse foramina from C3 to C7

The vertebral artery (VA) is often involved in the occurrence of complications after spinal manipulative therapy. Due to osteophytes compressing the VA anteriorly from the uncinate process or posteriorly from the facet complex, the VAs are susceptible to trauma in the transverse foramina. Such altered anatomical configurations are of major clinical significance, as spinal manipulations may result in dissection of the VA with serious consequences for the blood supply to the vertebrobasilar region. The purpose of this study is to describe numerous structural features of the third to seventh cervical vertebrae in order to contribute to the understanding of pathological conditions related to the VA. The minimal and maximal diameter of 111 transverse foramina in dry cervical vertebrae were studied. The presence of osteophytes and their influence on the VA were evaluated at the vertebral body and at the superior and inferior articular facets. The diameter of the transverse foramina increased from C3 to C6, while the transverse foramina of C7 had the smallest diameter. At all levels the mean dimensions of the left foramina were greater than those of the right side. Osteophytes from the uncinate process of C5 and C6 vertebrae were found in over 60% of dry vertebrae. Osteophytes from the zygapophyseal joints were more frequent at C3 and C4 vertebrae. About half of the osteophytes of the uncinate and of the superior articular process partially covered the transverse foramina. This was less common with those of the inferior articular facets. Osteophytes covering the transverse foramen force the VAs to meander around these obstructions, causing narrowing through external compression and are potential sites of trauma to the VAs potentially even leading to dissection. We strongly advocate that screening protocols for vertebrobasilar insufficiency (VBI) be used prior to any manipulation of the cervical spine and should include not only extension and rotation but any starting position from which the planned manipulation will be performed.     

The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region

Knowledge of the orientation of facet joints in the cervical and upper thoracic region is important for understanding the biomechanical properties and clinical conditions relevant to the neck. The study was undertaken on dry macerated bones from 30 adult male human vertebral columns. The orientation of the superior articular facets in relation to their inclination with the sagittal and transverse planes was examined between C3 and T3 vertebrae in each column. The linear dimensions of the superior articular facets and the width/height ratio were also calculated. The results show that all vertebrae at C3 level and 73% at C4 level displayed posteromedially facing superior articular facets. Similarly at T1 level (C7/T1 joint) and below, all columns showed posterolaterally facing superior articular facets. The level of change in orientation, from posteromedial to posterolateral facing superior facets, was not constant and occurred anywhere between C4 (C3/C4 joint) and T1 (C7/T1 joint). The change in orientation followed 2 different patterns, i.e. sudden or gradual. The C6 vertebra (C5/C6 joint) was the most frequent site to show the transition. The shape of the superior articular facets was circular to oval at C3, C4 and C5 levels and gradually changed to a transversely elongated surface at C7 and T1. These findings correlate well with various cervical movements and associated clinical conditions.     

Morphometric analysis of the thoracolumbar and lumbar pedicles,anatomo-radiologic study

The geometric properties of 380 vertebral pedicles, ranging from T6 to L5, were analysed. Measurement were made directly from the specimens as well as from roentgenograms. The parameters considered were the horizontal and vertical pedicle diameters, pedicle angles in the transverse and sagittal planes, and the transverse and anteroposterior widths of the spinal canal and vertebral body. In addition, the length of the pedicle and the length of the pedicle including the vertebral body to the anterior cortex were measured along the pedicle axis and in a line parallel to the midline of the vertebral body. The smallest horizontal and vertical pedicle diameters were found at vertebral levels from T6 to T10. The correlation between pedicle widths and screw dimensions is obvious. In the transverse plane, the pedicle angle diverged from the vertebral body at all levels, except at T12. In the sagittal plane, the pedicles were angled cephalad from T6 to L3 and slightly caudally at L5. Knowledge of the length of the pedicle to the anterior vertebral body cortex is very important for safe screw purchase. At all levels, with the exception of T12, this length was found to be significantly greater along the pedicle axis than along a line parallel to the midline of the vertebral body.     

Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images

The articular facet joints (AFJ) play an important role in the biomechanics of the spine. Although it is well known that some AFJ dimensions (e.g. facet height/width or facet angles) play a major role in spinal deformities such as scoliosis, little is known about statistical correlations between these dimensions and the size of the vertebral bodies. Such relations could allow patient-specific prediction of AFJ morphometry from a few dimensions measurable by X-ray. This would be of clinical interest and could also provide parameters for mathematical modeling of the spine. Our purpose in this study was to generate prediction equations for 20 parameters of the human thoracic and lumbar AFJ from T1 to L4 as a function of only one given parameter, the vertebral body height posterior (VBHP). Linear and nonlinear regression analyses were performed with published anatomical data, including linear and angular dimensions of the AFJ and vertebral body heights, to find the best functions to describe the correlations between these parameters. Third-order polynomial regressions, in contrast to the linear, exponential and logarithmic regressions, provided moderate to high correlations between the AFJ parameters and vertebral body heights; e.g. facet height superior and interfacet width (R2, 0.605-0.880); facet height inferior, interfacet height and sagittal/transverse angle superior (R2, 0.875-0.973). Different correlations were found for facet width and transverse angle inferior in the thoracic (R2, 0.703-0.930) and lumbar (R2, 0.457-0.892) regions. A set of 20 prediction equations for AFJ parameters was generated (P-values < 0.005, anova). Comparison of the AFJ predictions with experimental data indicated mean percent errors <13%, with the exception of the thoracolumbar junction (T12-L1). It was possible to establish useful predictions for human thoracic and lumbar AFJ dimensions based on the size of the vertebral bodies. The generated set of equations allows the prediction of 20 AFJ parameters per vertebral level from the measurement of the parameter VBHP, which is easily performed on lateral X-rays. As the vertebral body height is unique for each person and vertebral level, the predicted AFJ parameters are also specific to an individual. This approach could be used for parameterized patient-specific modeling of the spine to explore the clinically important mechanical roles of the articular facets in pathological conditions, such as scoliosis.     

Functional adaptations of facet geometry in the canine thoracolumbar and lumbar spine (Th10-L6).

The shape, size and transverse distance between contralateral caudal articular processes of caudal thoracic and lumbar vertebrae were evaluated in a sample of 140 macerated canine spines to contribute to the understanding of the development of vertebral misalignment. Dogs were grouped as large, chondrodystrophic, and small breeds. In large dogs, caudal articular surfaces were adapted to higher body-weight by the presence of larger articular surfaces. Additionally, caudal articular surfaces not only covered the lateral, but also the ventral (i.e. ventral facet) and/or caudal aspects (i.e. caudal facet) of the caudal articular processes. Ventral facets, which increase loading capacity of the zygapophyseal joints in normally aligned vertebrae, were more frequently observed in large breeds (p < 0.001) than in small and chondrodystrophic breeds. With some exceptions, caudal facets primarily were present in large dogs, especially at the vertebral levels L3-L5. Their formation is induced by extension of the normal lykphotic thoracic and lumbar spine causing lumbar lordosis and denotes loss in elasticity of the bow-and-string-construction of the trunk. Because ventral and caudal facets are consistent with convexity of the caudal articular surfaces, which to a great degree was noted to result in formation of ball-and-socket joints, spinal stability is supposed to be decreased under such conditions.     

胸腰椎椎弓根的解剖学测量及其临床意义

目的　观测胸腰椎椎弓根形态结构特征 ,为临床提供解剖学参数。方法　测量 31例成年男性椎骨T1～L5的横径、矢径、椎弓根间距及椎弓根通道长度。结果　横径 :T1～T6逐渐变小 ,T6～T12 逐渐增大 ,L1和L2 小于T12 ,L2 ～L5逐渐增大 ;矢径 :T1～T3 逐渐增大 ,T4～T7均小于T3 和T8,T7～T12 又逐渐增大 ,L1～L3 逐渐变小 ,L3 ～L5又逐渐增大 ,T1～L5均明显大于其横径 (P <0 0 1) ;模仿弓根通道长 :T1～T10 逐渐增长 ,T11和T12 均较T10 和L1短 ,L1～L4逐渐增长 ,L5较L4短 ;椎弓根间距 :T1～T4逐渐变窄 ,T5～L5逐渐增宽 ;左右侧比较无显著性差异 (P >0 0 5 )。结论　进行椎弓根螺钉固定时应根据不同节段椎弓根形态特点 ,结合影像学资料 ,选择相应的螺钉直径、长度、进钉部位及方向。     

腰椎峡部裂机翼型记忆合金节段内固定器研制的解剖学基础

目的　解剖测量L1～5, S1形态学参数为研制腰椎峡部裂机翼型记忆合金节段内固定器提供解剖学依据。 方法　采用20套正常成人腰骶椎标本测量L1～5,S1的相关参数,据此设计机翼型记忆合金节段内固定器。 结果 以L4/L5为例：(1)腰椎棘突下面两侧缘与椎板的交点至同侧横突根部上缘的距离(DITR)为(35.30±2.38)mm;(2)腰椎横突根部上缘前后两侧面的夹角(AFR)为(30.47±6.38)°;横突根部上下缘宽度(WRT)为(11.43±1.76)mm;(3)腰椎两侧横突、上关节突及椎弓根交界处中心点间距(DTAP) 为(46.44±2.55)mm;(4)腰骶椎棘突的厚度(TSP)为(9.04±1.12)mm;(5)腰骶椎棘突间距 (DAP)为(7.10±1.83)　mm;(6)腰椎棘突下面两侧缘与椎板的交点到横突根部、上关节突、椎弓根交界处中心点的连线和相应棘突下面侧缘的夹角（ATL）为(58.31±7.02)°;(7) 腰骶椎棘突后面到椎板的距离（LSP）为(20.40±2.80)mm。该内固定器由“U”形体部及两侧翼构成,初步设计大、中、小3个型号。 结论 机翼型记忆合金节段内固定器的设计在形态学上具有可行性,且利用了镍钛合金的记忆效应、超弹性、耐腐蚀等特性,是一种牢靠安全,操作简便的新型内固定器。     

Morphological parameters of the superior articular facets of the atlas and potential clinical significance

Background  Although remarkable investigations exist in regard to the morphology of the superior articular facets of the atlas in the literature, only a few data exist concerning the correlation of these facets with the age of the specimens. Methods  The superior articular facets of the atlas were studied in 86 dried vertebrae. Several non-metric parameters were recorded, like presence of notches, grooves, complete or partial dissociation, rough surfaces as well as their morphology. Results  No notch was found in 37.2% of the superior articular facets. The incidence of notch is decreased as the age progresses. No transverse groove was found in 24.4% and the presence is increased with the age. The incidence of complete and partial dissociations was also found to be age-related. The incidence of rough surfaces, which corresponds to the site of maximum weight bear, was found to be increased in the old age. We classified the shape of the facets into the following types: oval-shaped, kidney-shaped, S-like, triangle, circular and two portioned. Conclusions  We assume that the increase of incidence of the dissociation, the rough surfaces, the grooves and the decrease of notches could be possibly the result of a restriction of the atlanto-occipital motion in the old age.