管道疏通法行颈椎弓根螺钉置入的研究

目的：通过解剖学测量及临床应用探讨“管道疏通法”（dredging pipe method,DPM)对提高颈椎弓根螺钉置入的成功率、安全性及可操作性方面的应用价值。方法：（1）颈椎骨测量：成人C3－C7干燥骨42套，共210块椎骨，在实体及CT片上，测量椎骨的相关参数；92）临床应用：颈椎失稳症患者32例，术前X线、CT测量，参照标本及患者影像测量数据和管道疏通器自动寻迹的原理，个体化设计各椎节的置钉方案。在直视下显露椎弓根管口及其管腔，确定置钉方向和位置，扩孔攻丝置钉。术后观察对比相应指标，评价置钉的位置、方向。结果：91）与DPM相关的国人颈椎实体测量数据与CT测量数据比较无显著性差异（P＞0．05）；6．67％（28／42）椎弓根的宽度小于4mm;(2)32例患者共置入颈椎弓根钉146枚，术后CT复查96枚钉，其中5枚螺钉穿破椎弓根骨皮质，成功率94．8％。未出现神经血管损伤病例。结论：（1）术前影像学测量结果可人为个体化设计手术方案的重要依据，采用DPM置钉技术实施经颈椎弓根钉内固定手术，具有直视下操作、置钉准备率高、可操作性强等特点；（2）解剖学测量表明，极少部分人（6．67％）的C3－C7的椎弓根宽度不适宜做椎弓根钉内固定。

Placement of cervical spine pedicle screw with dredging pipe method

Objective:To explore a safety and efficacy technique(dredging pipe method,DPM)for transpedicular screw placement in cervical spine.Method:Forty-two dry samples of the pedicles(C3-C7)of human cadaveric cervical spines were measured associated with screw placement.The dredging pipe method for screw placement was designed based on those measurements and the automatic advancement principle of dredging pipe machine.The medullary canal of the pedicle and its introitus could be probed in direct vision.32patients with cervical instability underwent reconstrutive surgery including pedicle screw fixation and fusion with DPM.All patients were evaluated radiographically for the location of the pedicle screw.Result:No significant difference was found between the manual measurement and radiographic measurement of the cervical spine.146screws were inserted in32patients and96screws were assessed in CT plates.Minor pedicle wall violations were observed in5(5.2%)screws.The clinical status of the patient was improved significantly.Conclusion:Based on the results of preoperative radiographic measurements,DPM can be adopted for pedicle screw placement in cervical spine individually.The screw can be inserted in direct vision and the safety and accuracy of screw placement can be guaranteed with this method.