改良Abumi法行下颈椎椎弓根钉植入  

Modified Abumi technique on subaxial cervical pedicle screw insertion:A preliminary study on isolated fresh samples

作　　者：侯黎升[1] 阮狄克[1] 何勍[1] 徐云科[2] 叶晓健[3] 贾连顺[3] 徐成[1] 赵书臣[4] 张燕群[4] 张荣峰[5] 李威[1] 

机构地区：[1]北京海军总医院骨科,北京100037 [2]北京海军总医院放疗科,北京100037 [3]上海长征医院骨科,上海200003 [4]北京海军总医院放射科,北京100037 [5]中国人民解放军89医院脊柱外科,山东潍坊261200

出　　处：《颈腰痛杂志》2008年第4期291-295,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：海军总医院攻关课题资助(No2006院012)

摘　　要：目的探索改良Abumi法行下颈椎椎弓根螺钉植入的可行性。方法4具下颈椎的39例颈弓根(1例内横径(TID)<1.5mm排除在外)。对5例TID<3.0mm(组A)、3例3.0mm≤TID<3.5mm(组B),31例TID>3.5mm(组C)的椎弓根行改良Abumi法螺钉植入。先通过侧块松质骨刮除寻找椎板前壁(ACL)、上关节突前壁(ACS)和下关节突前壁(ACI)三者的汇聚点找到椎弓根入口(EP);再以椎弓根内壁(MCP)为参照,沿椎弓根髓腔钻孔。CT扫描明确孔道准确性。植入3.5mm直径螺钉后,再行CT扫描。结果钻孔后组B、组C的34例椎弓根四壁完整;组A的5例椎弓根外皮质(LCP)向外移位小于2mm。螺钉植入后CT复查,组C的椎弓根四壁保持完整,组B的LCP向外移位,组A的LCP向外进一步移位并骨折,但钉道方正确。结论改良Abumi法行下颈椎弓根螺钉植入能保持钉道正确。Objective To evaluate the practicability of modified Abumi technique on subaxial cervical pedicle screw insertion. Methods Thirty-nine subaxial cervical pedicles from 4 fresh sub- axial cervical vertebrae were selected for the modified Abumi manipulation （five,three and thirty- one whose transverse internal diameter （TID）were less than 3.0mm,no less than 3.0mm but less than 3.5mm and no less than 3.5mm,were classified to Group A,B and C,respectively,while one less than 1.5mm was excluded from the study）. The pedicle entry （EP）was exposed by removing cancellous bone posterior to anterior cortices of lamina,superior articularis and inferior articularis （ACL,ACS and ACI）after finding the converging center formed by these three cortices by sliding laterally and anteriorly on the exposed posterior surface of ACL meanwhile taking ACS and ACI as reference with a curette while noticing not touching cancellous bone posterior to posterior cortex of transverse foramen（PTS）for its thin and weak cortex. Appropriate bones lateral and posterior to PCT were then removed for ideal medial inclination of pedicle canal drilling （approximately 40-45°）. A 3mm-diameter pedicle probe was introduced to drill hole along the pedicle medullary canal by feeling inner surface of medical cortex of pedicle （MCP）as guide while taking superior cortex of pedicle（SCP）and inferior cortex of pedicle（ICP）as references. After CT scanning to clarify the tra- jectories＇ accuracy,a 3.5mm diameter screw was inserted to the pedicle trajectory following CT scanning again to confirm the integrity of pedicle walls. Results CT scanning after pedicle probe drilling showed integrities of SCP,MCP,ICP and LCP were preserved and trajectory paths accurate in all 34 pedicles in Group B and C. while the LCPs of the remaining 5 ones in Group A were displaced laterally but within 2mm （non-critical perforation）translation. CT scanning again after 3.5mm diameter screw insertion confirmed integrities of four walls and perfect traje

关 键 词：下颈椎 椎弓根 螺钉 椎弓根入口 Abum法 改良 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学] R687.32[医药卫生—基础医学]