胸腰段微创椎弓根钉置入的应用解剖

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。

Anatomical basis of minimally invasive pedicle screw implantation in thoracolumbar segments

BACKGROUND:Pedicle screw technology has been widely used in a variety of spinal surgeries, and it generally uses the classic back midline surgical approach. But in recent years, studies have found that some complications will be caused by this surgical approach. OBJECTIVE:To provide the anatomical basis for minimally 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, especially 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 paralleled with their corresponding arteries. When the minimally 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 will reduce the chances of posterior branch and blood vessel damage, which is an important technology for minimally invasive spine surgery.