手感法行颈椎弓根入口周缘及四壁强度比较的研究  

Resistance to Compression of Structures Adjacent to Pedicle Entry and Four Walls of Subaxial Cervical Pedicle:A Rough Comparison by Hand Feeling

作　　者：侯黎升[1] 阮狄克[1] 林井副[2] 何勍[1] 姜丽[2] 张燕群[2] 叶晓健[3] 徐云科[4] 徐成[1] 张荣峰[5] 崔洪鹏[1] 

机构地区：[1]海军总医院骨科,北京100037 [2]海军总医院放射科 [3]上海长征医院骨科 [4]海军总医院放疗科 [5]山东潍坊解放军第89医院脊柱外科

出　　处：《解剖与临床》2008年第2期78-80,84,共4页Anatomy and Clinics

基　　金：海军总医院攻关课题(2006院012)

摘　　要：目的：通过手感法比较颈椎弓根入口（EP）周缘及颈椎弓根四壁皮质强度。方法：采用2具新鲜下颈椎的20侧（C3～7）椎弓根，通过改良Abumi法暴露EP，以椎弓根内壁（MCP）为参照沿椎弓根髓腔钻孔。CT扫描证实EP四周及椎弓根四壁完整后，手持探针分别按压EP四周骨皮质，以感觉其强度差别。而后将探针插入椎弓根孔道内，向四壁撬拨，感受四壁皮质骨的强度差别。然后行CT扫描及肉眼观察证实手感是否正确。结果：EP处与LCP相移行的PCT最先穿破，施加更大压力后其它三壁仍保持完好；椎弓根外壁最先裂开移位，施加更大撬拨力后，其余三壁仍保持完好。CT扫描和肉眼观察均证实手感正确。结论：EP外侧的PCT菲薄，力学强度小，寻找EP时应以ACL为参照。椎弓根行径上LCP菲薄，力学强度小，椎弓根髓腔钻孔时，应以MCP为参照。Objective： To assess the strength difference of structures adjacent to pedicle entry （EP） and four walls of subaxial cervical pedicle by hand feeling. Methods：Two fresh subaxial cervical columns （20 pedicles） were selected for resistance assessment after modified Abumi manipulation to expose cortex structures adjacent to EP, and to drill screw trajectory by taking medial cortex of pedicle （MCP） as reference. Following thin-slice CT scanning confirming structures adjacent to EP were intact, integrity of pedicle＇s four walls was kept. A 2mm-diamter guide pin hold in hand was used to press on peripheric cortical plate to test their resistance difference. Then the pin was penetrated into the pedicle screw trajectory and pressed at different directions to assess the resistance difference of the peripheric cortex. CT scanning and direct observations were then introduced to confirm the corresponding structures＇ integrity. Results：Posterior cortex of transverse foramen （PCT） was the first to be perforated by pin ,compressing, ACS, ACL and ACI could keep their integrity even facing stronger compressing force comparing with that on PCT. The lateral cortex of pedicle （LCP） was the first to be break by pressing force, SCP, MCP and ICP could defend stronger pressing force with their structure intact. CT scanning and direct observation confirmed the accuracy of hand-feeling. Conciusions： PCT was the weakest structure among those adjacent to EP, one should avoid the manipulation tool too close to the PCT when exposing EP. LCP was the weakest among the pedicle＇s four walls, one should abstain from LCP when performing pedicle drilling.

关 键 词：椎弓根入口暴露 骨皮质 下颈椎 椎弓根钻孔 力学强度 

分 类 号：R687.3[医药卫生—骨科学]