经伤椎椎弓根螺钉复位治疗胸腰椎爆裂骨折的临床解剖学研究

目的:探讨经伤椎椎弓根螺钉复位内固定治疗胸腰椎爆裂骨折的解剖学基础。方法:在10具脊柱标本上模拟椎弓根螺钉内固定共拧入60枚螺钉,观察螺钉在椎体内的位置、椎体终板与螺钉的位置关系、前纵韧带和膈肌脚的位置及毗邻。结果:侧面观椎弓根螺钉于椎体上1/4处;冠状面观,螺钉位于椎体侧缘,距椎体边缘5～8mm,螺钉前端可直达椎体前缘;矢状面观,椎弓根螺钉紧贴上终板,距终板仅2～3mm。膈肌脚纤维粗大,左右各一,呈腱肌混合纵行,紧密附着于椎体前侧方。结论:(1)椎弓根螺钉在椎体内的位置是经伤椎椎弓根螺钉直接撬拨复位的解剖学依据;(2)腰大肌及膈肌脚纤维是经伤椎椎弓根撑开复位的软组织夹板样结构,可以充分利用这些结构特点进行伤椎复位;(3)经伤椎椎弓根螺钉内治疗胸腰椎爆裂骨折具有科学和可靠的形态学基础。

Clinical anatomy of the reduction and fixation through the pedicle of the injured vertebrae for the treatmeat of the thoracolumbar or lumbar burst fractures

Objective:To explore the possibility of a new method that treat the thoracolumbar or lumbar burst fractures through the pedicle of the injured vertebrae. Methods:Ten spine specimens were used to observe the position of the pedicle screw in vertebrae body,the relationship between the pedicle screw and the up-end-plate,the relationship between the anterior longitudinal ligament,the diaphragm crus and the major psoas. The pedicle screw and its adjacent structures were also investigated. Results:The major psoas,the anterior longitudinal ligament and the diaphragm crus and the posterior longitudinal ligament formed the soft-tissue splint of the vertebrae in thoracolumbar and lumbar spine,while the diaphragm crus played an important role in reduction of the vertebrae burst fracture through the pedicle of the injured vertebrae. The fracture mass were surrounded by these structure when the vertebrae were bursted. Conclusions:The anterior longitudinal ligament,the diaphragm crus and the major psoas are the structures taken as the splint of soft tissue when the fracture is reducted through the pedicle of the injured vertebrae.