X线监视下颈椎前路经椎弓根植入螺钉的安全性研究

目的：探讨X线监视下颈椎前路经椎弓根植入螺钉的安全性。方法取南昌大学基础医学院解剖学教研室经10％中性甲醛浸泡的新鲜尸体标本10具，以标本下颈椎C3-7为研究对象，CT扫描、重建并测量双侧椎弓根最大宽度及高度，并在X线透视定位下经前路植入椎弓根螺钉，CT 扫描、三维重建分析螺钉位置，同时根据Tomasino 法评价植入螺钉的安全性。结果10具尸体标本中共测量100个椎弓根的高度及宽度，其中有6个椎弓根宽度＜4.0 mm和2个椎弓根高度＜4.0 mm而不能植入螺钉。经前路椎弓根植入螺钉92枚，其中横断位：Grade 178枚，Grade 213枚，Grade31枚；矢状位：Grade 187枚，Grade 23枚，Grade 32枚。结论在术前个体化的CT扫描、重建分析颈椎椎弓根形态的前提下，X线监视下经前路植入下颈椎椎弓根螺钉是安全的。

Safety of Anterior Cervical Transpedicular Screw Placement under X-ray Monitoring

Objective To investigate the safety of anterior cervical transpedicular screw placement under X-ray monitoring. Methods Ten fresh adult cadaveric specimens preserved in the formaldehyde solution were obtained from Department of Anatomy of School of Basic Medical Sciences of Nanchang University. The bilateral cervical pedicle （C3-7） height and width for anterior transpedicular placement were measured by CT scan and reconstruction. Anterior cervical transpedicular screws were implanted into the cadaveric pedicles under X-ray monitoring. The position of screws was evaluated by CT and reconstructed images. The safety of screws was evaluated using Tomasino’s method. Results Of the 100 pedicles measured, 8 were too small to insert the screw （the width was less than 4.0 mm in 6 and the height was less than 4.0 mm in 2）. Ninety-two screws were implanted successfully. In sectional plane, 78 screws were grade 1, 13 screws were grade 2 and 1 screw was grade 3. In sagittal plane, 87 screws were grade 1, 3 screws were grade 2 and 2 screws were grade 3. Conclusion The cervical anterior transpedicular screw under X-ray monitoring is safe under the premise of individualized preoperative CT scan and reconstruction analysis of cervical pedicle morphology.