以棘突连线确定矢状面进钉角度在胸腰椎内固定治疗中的应用

背景：理想的胸腰段骨折复位需要准确的椎弓根钉置入角度以达到理想的应力作用,近年来国内外有很多专家学者设计了多种方法,基本以椎体或附件本身的解剖结构设计某一平面作为参考,精确程度不一。 目的：选择棘突连线作为胸腰段骨折内固定手术中椎弓根螺钉与终板保持平行的参照并给出理论依据。 方法：选择49例正常胸腰段和21例胸腰段骨折(无棘突骨折)MRI片测量椎体上终板平行线与相应棘突连线的夹角,两者比较并进行统计学对比分析。 结果与结论：正常胸腰椎椎体上终板平行线与棘突连线夹角在T₁₀-L₃基本为90°,在L₄处为82°左右,而椎体骨折后所测角度差别不大。结果提示在胸腰椎骨折内固定手术过程中,如果保持椎弓根螺钉与棘突连线夹角在T₁₀-L₃为90°,L₄为80°左右,基本能够保证椎弓根螺钉与终板保持平行,将棘突连线作为螺钉置入的参考解剖标志在理论上是可行的。

Application of sagittal screw angle based on supraspinous line in the treatment of thoracolumbar fixation

BACKGROUND:Ideal reset of the thoracolumbar fractures needs accurate pedicle screw placement angle to achieve the desired stress. In recent years, a variety of means have designed by the experts and scholars at home or abroad, almost all the means are aimed to design a plane with the reference of the anatomical structure of vertebral body or attachments, so accurate degree is not uniform. OBJECTIVE:To analyze whether supraspinous line can be the identification marker of the sagittal screw angle of the pedicle of vertebral arch in the thoracolumbar surgery． METHODS:A total of 49 cases of the nomal thoracolumbar MRI images and 21 cases of T₁₂ thoracolumbar fracture MRI images were included in the study to measure the angle of the vertebral body terminal plate parallel lines and the corresponding supraspinous lines. The comparison and statistical comparative analysis were performed. RESULTS AND CONCLUSION:The angle of vertebral body terminal plate against supraspinous line was 90° at T₁₀-L₃, and was about 82° at L₄. The angle was not changed before and after thoracolumbar fracture. In the internal fixation surgery of thoracolumbar fracture, if the angle of vertebral body terminal plate against supraspinous line is about 90° at T₁₀-L₃ and 80° at L₄, the pedicle screw and terminal plate may be maintained in parallel basically. Supraspinous line can be the identification marker for sagittal screw angle of the pedicle of vertebral arch.