腰骶椎经皮椎弓根螺钉相关放射学数据测量及临床意义  

Measurement of imaging parameters related to the percutaneous lumbosacral pedicle screw placement and their clinical significance

作　　者：郭虎兵[1] 刘瑾[1] 谈敬忠 黄杰[1] 陈立启[1] 于新福[1] 

机构地区：[1]甘肃天水市第一人民医院骨一科,741000

出　　处：《中国矫形外科杂志》2015年第18期1657-1661,共5页Orthopedic Journal of China

基　　金：甘肃省卫生行业科研计划项目(编号:GSWST2013-18)

摘　　要：[目的]为腰骶椎经皮椎弓根螺钉置入提供直观的影像学数据资料。[方法]测量245例成人腰骶椎X线片及CT片相关数据,包括L1~S1各椎弓根横径及纵径、椎弓根间距、上下相邻椎同侧椎弓根间距、椎弓根轴线与上关节突后缘及椎体前缘交点间距、椎弓根水平位穿刺角（transverse puncture angle,TPA）、椎弓根矢状位穿刺角（sagittal puncture angle,SPA）。[结果]椎弓根横径从L1~5呈逐渐增大趋势,纵径从L1~3逐渐减小,L4、5纵径似有渐增趋势但均〈L1~3,而S1纵径及横径均变小。椎弓根间距从L1~5呈逐渐增大,相邻椎体同侧椎弓根间距从L1~S1逐渐减小。这些数据男女性别间差异有统计学意义（P〈0.05）。TPA从L1~S1逐渐增大,SPA从L1~S1由正变负,增大趋势明显,男女性别间差异无统计学意义（P〉0.05）。[结论]腰骶椎椎弓根大小、椎弓根间距、上下相邻椎同侧椎弓根间距、TPA、SPA呈规律变化,在经皮椎弓根螺钉置入穿刺手术中利用相应数据有利于穿刺点的定位,同时遵循变化规律可以增加穿刺成功率。[ Objective] To provide imaging data for the percutaneous lumbosacral pedicle screw placement. [ Method ] Measurement of CT scanning images and X - ray films was conducted in 245 Chinese adults. The anatomic data involved every vertebra from L1 to SI ,including the transverse and sagittal diameter of pedicle,distanee between two pedieles of the same verte- bral body,distance between two ipsilateral adjacent pedicles, distance between superior articular process and anterior edge of vertebral body on axis of the pedicle, transverse puncture angle of pedicle （ TPA ） , and sagittal puncture angle of pedicle （SPA）. [ Result] The transverse diameters of pedicle gradually increased from L1 to S1. However, the sagittal diameters of pedi- ele gradually decreased from L1 to L3, nevertheless increased again from L4 to L5 where they were smaller than those at L1- 3- Both the transverse and sagittal diameter of S1 pedicle became smaller. Additionally, the distances between two pedicles of the same vertebral body gradually increased from L1 to S1 ,associated with significant differences in gender （P 〈0.05）. The degree of TPA changed from negative value to positive value, but the degree of SPA changed contrarily, in which the difference between the male and female groups was not significant （ P 〉 0.05 ）. [ Conclusion ] There are regular variations in the imaging parame- ters,including the size of pedicle, distance between two pedicles, distance between two ipsilateral adjacent pedicles, length of pedicles, TPA, and SPA. In clinical setting of percutaneous pedicle screw placement, the above data will contribute to locate the puncture point correctly,increase successful rate of the puncture.

关 键 词：腰骶椎 经皮椎弓根螺钉 解剖数据 

分 类 号：R687.3[医药卫生—骨科学]