经后路椎体次全切除和钛网加钉棒重建术的解剖学研究  

Anatomic study of posterior subtotal corpectomy wiht titanium mesh support and pedicle screw fixation

作　　者：林慰光[1] 胡奕山[1] 郑干轩[1] 张秀红[1] 林本丹[1] 赵卫东[2] 

机构地区：[1]广东省汕头市中心医院外七科,515031 [2]南方医科大学解剖教研室,广州510515

出　　处：《广东医学》2013年第16期2441-2442,共2页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:B2011299)

摘　　要：目的通过解剖胸腰椎的不同部位,了解适合该部位的最佳钛网直径与长度以及最佳的置入姿势。方法选用5具陈旧性成年男性尸体的躯干,选取T10、L1、L3给予解剖,模拟经后路行椎体次全切除后,以不同长度和直径的钢管模拟钛网置入,在尽量保护硬寂寞囊和相应神经根的前提下,测量置入钢管的平均最大允许直径和长度,并获得最佳的置入姿势。结果在T10、L1、L3中,钢管的平均最佳直径分别为(1.54±0.05)、(1.94±0.04)、(1.96±0.05)cm,平均最佳长度分别为(2.92±0.11)、(3.24±0.09)、(3.32±0.11)cm。经过多次尝试,认为相对于垂直翻转,斜向下前的方向更有利于钛网的置入。结论临床上,在胸椎、L1和其他腰椎中行后路椎管减压、椎体次全切除、钛网支撑加椎弓根钉内固定术,钛网的最佳直径可能分别为1.54、1.94、1.96 cm,而最佳长度分别可能为2.92、3.24、3.32 cm;斜向下前方置入钛网有利于手术操作。Objective To find the optimum diameter and length for titanium-net and the best placement position through anatomizing different parts of thoracolumbar spine.Methods Five adult male corpses were adopted,from which T10,L1 and L3 vertebrae were selected for simulation of subtotal corpectomy with posterior approach.Steel pipes with different diameters and lengths were used for replacement of titanium-net.The best diameter and length of the steel pipe within the allowable range and the best placement position were assessed.Results The best diameters of steel pipes were for T10,L1 and L3 were 1.54 ± 0.05,1.94 ± 0.04 and 1.96 ± 0.05 cm,respectively;while mean best lengths were 2.92 ± 0.11,3.24 ± 0.09 and 3.32 ± 0.11 cm,respectively.The oblique underside in front direction was the most conducive to the placement of titanium-net.Conclusion In clinical,the optimum diameters and lengths of titanium-net for thoracic,L1 and the other lumbar vertebrae in spinal canal decompression,subtotal corpectomy titanium-net support and pedicle screw fixation with posterior approach are 1.54 and 2.92 cm,1.94 and 3.24 cm,and 1.96 and 3.32 cm,respectively.The oblique underside in front direction to insert the titanium-net is conducive to surgical operation.

关 键 词：椎体次全切除 钛网 椎弓根钉 解剖学 

分 类 号：R681.550.5[医药卫生—骨科学]