颈椎椎弓根三种置钉法的实验研究

目的: 评价 3种颈椎椎弓根置钉方法。方法: 3组尸体各 9具, 行颈椎CT影像测量后分别用 3种方法进行椎弓根置钉, 其结果由CT验证。结果: 颈椎椎弓根三维定位器法置钉 90枚, 椎弓根内占 90%, 其中神经根损伤 2枚, 椎动脉损伤 1枚; Abumi法置钉 90枚, 椎弓根内占 55. 56%, 其中神经根损伤 19枚, 椎动脉损伤 4枚; Ebraheim法置钉 72枚, 椎弓根内占 29. 17%, 其中神经根损伤 24枚, 椎动脉损伤 29枚, 3种方法均无脊髓损伤。结论: 在术中不探查椎弓根、无影像设备导向条件下, 颈椎椎弓根三维定位器置钉准确率较Abumi手法置钉高, 而Ebraheim法不适用于国人。

Experimental study of three insertion techniques of cervical pedicle screw

Objective: To evaluate three insertion techniques of cervical pedicle screws.Method:Twenty seven adult cadavers were randomly divided into three groups,Cervical Pedicle Three Dimensional locator technique,Abumi technique and Ebraheim technique which included 9 samples respectively, the cadaveric cervical pedicles were placed with 2mm nails according to three techniques.Results of all samples were assessed by CT scan.Result:In group Cervical Pedicle Three Dimensional locator techniques, 90 cervical pedicles nails were placed,90% of the nails were placed entirely within the pedicle; 10% had a pedicle cortex breach,among them,the nerve root was injured by 2 nails,the vertebral artery was injured by 1 nail.In group Abumi techniques,90 cervical pedicles nails were placed, 55.56% of the nails were placed entirely within the pedicle;44.4% had a pedicle cortex breach, among them, the nerve root was injured by 19 nails, the vertebral artery was injured by 4 nails. In group Ebraheim techniques,72 cervical pedicles nails were placed, 29.17% of the nails were placed entirely within the pedicle; 70.83% had a pedicle cortex breach, among them, the nerve root was injured by 24 nails,the vertebral artery was injured by 29 nails.No spinal cord injury were found in all the three groups.Conclusion:Without guidance of roentgenography and exploration of pedicle,the Cervical Pedicle Three Dimensional locator technique can achieve a higher accurate rate of insertion manipulation, while in the same condition,Abumi techniques gives rise to relatively high failure rate of screw insertion.The Ebraheim techniques misfits Chinese.