胸椎上关节突基底外1/3点为椎弓根进钉点的应用解剖

目的:研究胸椎上关节突基底外1/3点与椎弓根的解剖关系,为胸椎椎弓根穿钉提供一种新的定位方法。方法:选取45具成人干燥骨标本(男25具,女20具),测量胸椎上关节突基底外1/3点至相应椎弓根上缘、下缘、中轴线垂直距离,至内缘、外缘、中轴线水平距离,最适内倾角度、最适尾倾角度、最大内倾角度、最大尾倾角度。据测量结果设置穿钉参数,在5具尸体上模拟穿钉,CT评价螺钉位置。结果:各组长度、角度之性差比较无显著统计学意义(P>0.05)。胸椎上关节突基底外1/3点在椎弓根上缘、下缘、内缘、外缘所成框内,与椎弓根中轴线接近;最适内倾角度T1￣T3为25°,T4￣T10为15°,最适尾倾角度10°,据此参数在5具尸体上模拟穿钉均获成功。结论:胸椎上关节突基底外1/3点作胸椎椎弓根穿钉定位点,具有准确、可靠、简单实用等优点,是一良好的解剖定位标志。

An transpedicular entry point located at the outer one-third point of the bottom of the superior facet of thoracic vertebra:An applied anatomy study

Objective: To determine a new transpedicular localization point of thoracic vertebra through investigating the anatomical relationship of the outer one-third point of the bottom of the superior facet and the pedicle of vertebral arch.Methods: Forty-five adult dehydration specimens (male 25, female 20) were obtained to measure dimensions of the outer one-third point of the bottom of the superior facet to superior border,inferior border,lateral border,medial border and to axis of pedicle.The transverse angle and the sagital angle were also measured.Screw penetration was modeled on five cadavers,and then observed with CT scans. Results: No sex difference was found in any groups(P>0.05).The outer one-third point of the bottom of the superior facet located at the zone enclosed by the superior border,the inferior border,the lateral border and the medial border of pedicle,and was adjacent to the axis of pedicle.The transverse angle was 25 degrees at T1~T3 and 15 degrees at T4~T10, while the sagital angle was 10 degrees.Based on these parameters, screw penetration was modeled on five cadavers successfully. Conclusion: The outer one-third point of the bottom of the superior facet was a simple,accurate and dependable entry point of thoracic transpedicular screws.