腰骶移行椎S_1椎弓根解剖测量及临床应用

目的探讨腰骶移行椎S1椎弓根进钉方法及临床初步应用效果。方法测量17例腰骶移行椎标本及30例正常骶骨标本的S1椎椎弓根横径、上下径、椎弓根中心轴线长度及角度,采用特定进钉点治疗15例腰骶移行椎患者。结果根据测量结果确定椎弓根螺钉置钉点。S1椎弓根横径:腰骶移行椎(22.47±4.67)mm,正常椎(26.72±3.76)mm(P0.05)。上下径:腰骶移行椎(20.71±2.97)mm,正常椎(25.38±4.62)mm(P0.05)。椎弓根中心轴线长度:腰骶移行椎(41.27±5.65)mm,正常椎(49.83±6.72)mm(P0.05)。移行椎椎弓根A角:腰骶移行椎6.54°±1.98°,正常椎6.31°±1.72°(P0.05);B角:腰骶移行椎43.55°±11.21°,正常椎35.71°±10.63°(P0.05)。腰骶移行椎的上关节突形态与正常者相近,但双侧不对称者多见。腰骶移行椎17例中11例出现不对称,正常椎30例中2例不对称,两者比较差异有统计学意义(P0.05)。V形槽形态在正常骶骨中不易见到,在腰骶移行椎中出现率为100%。结论腰骶移行椎后部横突变异,上关节突不对称率高,而V形槽出现恒定。以V形槽外缘3 mm处为纵线,以上关节突关节面下缘水平线为横线,其交点作为椎弓根螺钉进钉点。角度选择A角在6°左右、B角在43°左右,长度选择35~40 mm之间,临床应用收到理想疗效。

The measurement of the pedicle screw insertion of the lumbosacral tiansitional vertebrae and its clinical application

Objective To study the anatomical basis for pedicle screw insertion of the lumbosacral transitional vertebrae. Methods 17 dry lumbosacral transitional vertebrae specimen and 30 dry sacrum specimen were anatomical measured. The transverse diameter and the sagittal diameter of the pedicle screw insertion, the length of pedicle axis and angle of 15 cases were measured. Results The transverse diameter was （22. 47 ± 4. 67）mm in lumbosacral transitional vertebrae, （26. 72 ±3. 76）mm in normal vertebrae（P 〈0. 05）. The upper antero-posterior diameter was （20. 71 ±2. 97）mm in lumbosacral transitional vertebrae , and （25. 38 ±4. 62）mm in normal vertebrae（P 〈0. 05）. The length of pedicle axis（41. 27 ±5. 65）mm in lumbosacral transitional vertebrae, and （49. 83 ±6. 72）mm in normal vertebrae（P 〈 0. 05）. the angle A 6. 54° ± 1. 98° in lumbosacral transitional vertebrae, and 6. 31° ± 1. 72° in normal vertebrae（P〉 0. 05）;the angle B 43. 55° ± 11. 21° in lumbosacral transitional vertebrae,and 35. 71° ± 10. 63° in normal vertebrae（P 〈0. 05）. Facet normal morphology and lumbosacral transitional vertebrae were similar, but bilateral asymmetry were more common. Lumbosacral transitional vertebrae 17 cases in 11 cases appeared asymmetrical, 30 cases of normal vertebral asymmetry were found in 2 cases （P 〈0. 05）. V-shape incisures in the normal form of the sacrum was not easy to see, but there was 100% in the lumbosacral transitional vertebrae. Conclusions The transverse process variation of lumbosacral transitional vertebrae, point of pedicle screw insertion of the V-shape incisures outer edge 3 mm for pedicle screw insertion through posterior approach is easy way that leads to a very high success rate. The angle A about 6°,and angle B about 43° are choosed, the length 35 -40 mm is chose.