胸椎经横突-椎体螺钉固定入路的放射解剖学研究及意义

目的 为避免胸椎椎弓根手术的危险因素,在横突解剖研究的基础上设计了经横突-椎体螺钉固定术式,对这一术式入路进行放射解剖学研究.方法 通过观测60例成人胸椎CT,对术式路径的长度、宽度、进钉角度进行放射解剖研究,并与经椎弓根固定术式进行统计学比较分析.在此基础上用5具尸体的T～T10节段模拟穿钉,并做出穿钉准确性评价.结果 经横突-椎体螺钉固定术式可有两条入路,其入路长度、角度存在差异,差异有统计学意义(P<0.05);这一术式与经椎弓根术式相比具有更大的路径长度、宽度及内倾角度,差异有统计学意义(P<0.01);根据入路解剖参数在5具尸体的T1～T10节段上模拟穿钉发现这一术式两条入路的螺钉位置均满意,未见神经、血管损伤.结论 经横突-椎体螺钉固定术式是可行的,此术式比椎弓根术式路径长、宽度大,更加安全可靠,可相对减少椎弓根术式的危险.

Screw fixation from transverse process to vertebral body in thoracic spine:a radio-anatomic study

Objective To study the design of a new screw fixation from transverse proeess to vertebrae body which is supposed to avoid the risk of thoracic transpedicular fixation. Methods Sixty adult thoracic CT scans were obtained for the study.A radio-anatomic study was conducted to observe the lengths,widths and angles of screw insertion of the approaches for this fixation method.A statistical comparison was conducted between this fixation methed and transpedicular fixation method.Based on the study,screws were inserted on 5 fresh cadavers from T1 to T1O segments,and accuracy of Screw in. Sertion was assessed.Results Significant differences were observed in the length and angle between the 2 approaches for the new fixation method(P<0.05).The 2 new approaches provided significantly larger length,width and sagittal angle than the transpedicular approach(P<0.01).Based on the anatomic pa- rameters,screw insertion on 5 fresh cadavers from T1 to T1O segments was satisfactory.leading to no injury to the nerves or blood vessels. Conclusion The screw fixation from transverse process to vertebrae body is clinically feasible and safer and more reliable than the transpedicular method.