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上胸椎椎板螺钉内固定可行性的解剖学研究

The anatomical feasibility analysis of posterior laminar screw fixation techniques in upper thoracic vertebrae

摘要:

目的 探讨T1~T3交叉椎板螺钉技术用于成人内固定的可行性及其技术方法.方法 取33具成人完整干燥T1~ T3椎体标本,男性21具,女性12具,年龄26 ~ 69岁,平均57岁.测量上胸椎T1、T2、T3棘突根部的高度、左右侧椎板高度、上椎板和下椎板螺钉钉道长度、两侧椎板的厚度、椎板内侧面上缘和下缘夹角.通过改良的Kretze技术,直视下T1模拟置入上、下位椎板螺钉,直视及X线评价螺钉的位置.结果 T2的棘突最高为(15.7±1.6) mm; T3的椎板最高为(18.7±1.1)mm.T1的上、下椎板螺钉钉道分别为(31.7 ±2.4) mm、(37.3±2.3)mm,T2的分别为(25.8±2.2) mm、(32.3 ±2.7)mm,T3的分别为(25.3 ±2.7)mm、(31.2 ±2.9)mm;相同节段的上位椎板螺钉的钉道长度均较下位的短.T1、T2、T3椎板厚度分别为(6.3±0.9)mm、(6.9±1.0) mm、(6.5 ±0.9)mm;T2椎板厚度最厚,其与T1比较差异有统计学意义(t=8.876,P<0.01),与T3比较差异无统计学意义(P>0.05).椎板内侧面夹角分别为101.8°±4.5°、l01.9°±4.3°、102.9°±4.4°.相同节段左右侧椎板高度和厚度比较,差异均无统计意义(P>0.05).模拟螺钉成功置入,未发现螺钉侵犯椎管.结论 大部分成人上胸椎可以进行交叉椎板螺钉内固定,测量结果可为临床应用提供参考.

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abstracts:

Objective To investigate the anatomical feasibility and the technique of T1 -T3 crossing laminar screws fixation in the adult population. Methods There were 33 dry upper thoracic vertebras specimen which included respectively T1,T2,T3 were studied. Spinous process height ( Hs ),bilateral laminar height( H),length of superior laminar screws(Ls),length of inferior laminar screws (Li),bilateral thickness of laminar( TL ) and crossing angle the laminar ( A ) were measured.On the basis of modified Kretze's technique,T1 crossing laminar screws implantation was performed under visual control.The crossing laminar screws position were evaluated by X-ray and visualizing. Results The mean Hs of T1 was the highest which was ( 15.7 ± 1.6) mm ;the mean H of T3 was the highest which was ( 18.7 ± 1.1 ) mm;the TL and A of T1 were (6.3 ±0.9)mm and 101.8° ±4.5°,that of T2 were (6.9 ± 1.0)mm and 101.9° ±4.3°,that of T3 were (6.5 ± 0.9 )mm and 102.9° ± 4.4°,respectively. There were no significant differences between the values of the H and TL on left and right sides ( P > 0.05 ).The Ls of T1,T2,T3 were shorter than Liofthat [(31.7 ±2.4)mm vs.(37.3±2.3)mm,(25.8±2.2)mm vs.(32.3 ±2.7)mm,(25.3 ±2.7) mm vs.(31.2 ± 2.9 )mm,respectively].There was significant statistically difference between the values of the Ls and Li on the same vertebra(P <0.05).The mean TL of T2 was the thickest,which was significant statistically thicker than that of T1 (t =8.876,P < 0.01 ),which was not significant statistically thicker than that of T3 ( t =1.919,P > 0.05 ).The T1 crossing laminar screws were successfully placed,without impingement of the spinal canal.Conclusions It is feasible to place T1,T2,T3 crossing laminar screws in most people.This study provides anatomic guidelines to allow for accurate screw selection and insertion.

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作者: 胡庆丰 [1] 徐荣明 [2] 潘浩 [1] 周辉 [1] 朱杭 [1] 夏志敏 [1]
第一作者: 胡庆丰
期刊: 《中华外科杂志》2012年50卷3期 268-271页 MEDLINEISTICPKUCSCD
分类号: R323
栏目名称: 临床解剖学研究
DOI: 10.3760/cma.j.issn.0529-5815.2012.03.020
发布时间: 2012-04-20
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