腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究  

Surgical anatomical study of accuracy entrance point for the placement of pedicles screw through posterior approach

作　　者：杜心如[1] 赵玲秀[1] 张一模[1] 叶启彬[2] 

机构地区：[1]承德医学院附属医院骨科,河北承德067000 [2]北京协和医院骨科,北京100730

出　　处：《中国临床解剖学杂志》2002年第2期86-88,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:研究以腰椎人字嵴顶点椎弓根螺钉进钉点的解剖学基础。方法:在１００套成人干燥腰椎骨标本上对人字嵴的出现率、人字嵴顶点与椎弓根中心的关系进行了观测。结果:①腰椎人字嵴出现率为９４．８%。其中Ｌ１为９６．７%;Ｌ２为９８．９%;Ｌ３为１００%;Ｌ４为９９%;Ｌ５为８１%;②进钉角度:Ｌ１为５．１°±４．７°;Ｌ２为６．２°±３．７°;Ｌ３为７．５°±３．２°;Ｌ４为８．９°±３．３°;Ｌ５为１０．７°±７．９°。③进钉深度:Ｌ１为(４．３±０．３)ｃｍ;Ｌ２为(４．３±０．３)ｃｍ;Ｌ３为(４．５±０．４)ｃｍ;Ｌ４为(４．３±０．３)ｃｍ;Ｌ５为(４．１±０．３)ｃｍ。结论:①腰椎的人字嵴结构恒定存在,变异小,且不受退变影响;②人字嵴顶点位于或接近椎弓根中心,不需过多地显露横突和关节突关节,是一种简单、实用的进钉方法。Objective: To study the anatomical basis of regarding the A shape crest of the lumbar spine as a inserting landmark of pedicle screw. Methods: One hundred dry lumbar specimens were used for this study. Anatomical evaluation focused on the determination of the ' ∧ 'shape crest and the relationship between the top point of the crest and the lumbar pedicle center. Results: The appearance rate of the ' ∧ 'shape crest was 96.7% in L1, 98. 9% in L2 , 100% in L3, 99% in L4 and 81 % in L5 . The outward tilt angles of the screw entrancing into pedicles were as follows: 5.1°±4.7°inL1, 6.2°±3.7°in L2, 7.5°±3.2°in L3, 8.9°±3.3°in L4, and 10.7°±7.9°in L5. The entrance depth was 4.3°±0.3°cm inL1,4.3°±0.3°cm inL2,4.5°±0.4°cm in L3,4.3°±0.3°cm inL4 and 4.1 °±0.3°cm in L5. The entrance point of this method was almost in the center of the pedicles. Conclusions: The '∧' shape crest is easily exposed and identified in the operation, and it is needless to exposed the transverse process. The screw should slant obliquely outward at an angle of 5°- 10°in L1 - L4, 10°- 15°n L5 and the depth of the screw insertion was 4.0-4. 5cm in our method. The new landmark of screw entrance point appears to offer an easy way for insertion of the pedicle screw that leads to a very high success rate of screw insertion through posterior approach.

关 键 词：腰椎 椎弓根 螺钉进钉点 解剖 内固定 

分 类 号：R687.32[医药卫生—骨科学]