下颈椎椎弓根入口内壁探测法行根钉置入的可行性研究  

Medial-Cortex Detection Technique of Pedicle Entry for Subaxial Cervical Pedicle Screw Insertion:A Preliminary Study on Isolated Fresh Cervical Columns

作　　者：侯黎升[1] 阮狄克[1] 何勍[1] 徐云科[2] 林井付[3] 徐成[1] 赵书臣[3] 辛洪奎[1] 崔洪鹏[1] 

机构地区：[1]北京海军总医院骨科,100037 [2]北京海军总医院放疗科,100037 [3]北京海军总医院放射科,100037

出　　处：《解剖与临床》2008年第1期13-16,共4页Anatomy and Clinics

基　　金：海军总医院攻关课题

摘　　要：目的:评价椎弓根入口内壁探测法行新鲜下颈椎椎弓根钉置入的可行性。方法:采用6具新鲜成人尸体下颈椎的60侧椎弓根。在下关节突下缘的外1/4处咬除后方骨皮质,形成大小约5mm开口;刮勺内倾50°刮除开口内侧松质骨达椎板前皮质,转向外探明椎弓根入口,用直径3mm探针以椎弓根内壁为参照钻孔。DR拍片、CT扫描观察钉道准确性。结果:DR片可满意观察钉道矢状面。CT示54侧钉道完全在髓腔内(90%),3侧椎弓根外皮质部分胀开,2侧外皮质胀破并移位,1侧髓腔闭塞,钉道进入横突孔。结论:入口内壁探测法行下颈椎椎弓根钉置入效果满意。Objective： To evaluate efficacy of medial - cortex detection technique of pedicle entry （MCDTPE） for subaxial cervical pedicle screw insertion. Methods：Six isolated subaxial cervical columns （ sixty pedicles） were included in the study. First, posterior cortex of lateral mass at lateral 1/4 region at base of superior articularis was removed to form a 5mm - diameter opening. Second, posterior surface of anterior cortex of ipsilateral lamina （ACL） close to entry of pedicle （EP） was exposed by removing cancellous bone posterior to it with a 2mm - diameter curette. Third, moved the curette laterally along the posterior surface of ACL to find EP. Fourth, penetrated a 3 - mm diameter probe and advanced it along the marrow cavity by feeling the boundary of medial , superior , and inferior cortex of pedicle（ MCP, SCP and ICP）. DR films, CT scanning were then done to confirm the accuracy. Results：DR film showed all screws placed correctly on sagittal plane. CT scanning showed 54 （90%） trajectory paths were enclosed entirely within the pedicle,5 had a noncritical breach of the LCP（ LCP bulged laterally with continuity intact in 3 and interrupted in 2）, 1 trajectory entered the medial side of transverse foreman because of obstruction of pedicle cavity. Conclusion： MCDTPE could provide satisfactory accuracy for lower cervical pedicle screw insertion on fresh isolated cervical samples.

关 键 词：内壁探测法 椎弓根入口 下颈椎 螺钉 皮质厚度 

分 类 号：R687.3[医药卫生—骨科学]