成人腰椎皮质骨钉道的解剖学研究  

Anatomic study on lumbar cortical bone trajectory of adults

作　　者：陈文杰[1] 王洪立[1] 姜建元[1] 吕飞舟[1] 马晓生[1] 夏新雷[1] 王立勋[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2015年第12期1213-1221,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金，上海市科学技术委员会科研计划医学重点项目

摘　　要：目的测量正常成人腰椎皮质骨钉道的手术相关解剖学参数，探讨皮质骨螺钉应用的可行性及规格尺寸。方法随机选取18~40岁成人腰椎三维cT影像资料，男女各40名。在腰椎各节段左右两侧以上关节突中垂线与横突下1mm水平线的交点为进钉点，经过椎弓根水平与矢状面骨质最凹陷处连线的中点，止于椎体上终板或外侧壁。测量腰椎各节段冠状面椎弓根长径、横径，矢状面与横断面进钉角度、安全范围、螺钉长度及直径、进钉点至椎板外侧缘距离及相对椎弓根通道所在位置，统计不同性别、不同侧别、不同节段解剖学参数的差异。结果各节段左、右两侧解剖学参数的差异均无统计学意义。L1-L5节段螺钉平均进钉长度分别为（37．56±2．41）mm、（38．72±2．36）mm、（39．51±2．51）mm、（39．78±2．87）mm、（38．83±2．74）mm，平均直径分别为（6．04±1．23）mm、（6．17±1．24）mm、（7．15±1．22）mm、（8．02±1．41）mm、（8．68±1．42）mm。L1～L5节段的理想进钉角度差异无统计学意义，平均外偏角分别为8．46°±2．11°、9．37°±2．84°、9．62°±2．16°、9．53 °±1．98°、9．04°±1．97°，平均头倾角分别为26．49°±4．97°、25．94°±4．56°、26．42°±4．42°、26．29°±3．48°、26．89°±3．69°。L1-L5节段进钉点至椎板外侧的平均距离呈递增趋势，分别为（1．19±0．75）mm、（1．54±1．08）mm、（2．01±1．45）mm、（3．49±1．52）mm、（4．47±1．32）mm，两两比较差异均有统计学意义。男性各节段螺钉直径均大于女性，差异有统计学意义。结论正常成人腰椎皮质骨钉道螺钉常用长度规格为35±40mm，各节段螺钉直径安全上限为L1 5．5mm、L2 5．5-6．0mm、L，6．5—7．0mm、L47．5mm、L58．0mm。腰椎各节段置钉平均外偏角为9．20°±2．11°、平均头倾角为26．41°±4．22°。Objective To determine anatomic parameters related to the surgery of lumbar cortical bone trajectory of nor- real adults and the feasibility of screw application in cortical bone and its specification and dimension. Methods Lumbar 3D im- age data of 80 adults between 18 and 40 years old （40 for each gender） were randomly selected as subjects of our research. With the help of the imaging software for 3D interactive viewing, the ideal starting point was supposed to he the junction of the center of the superior articular process and 1 mm below the inferior border of the transverse process. The diameter, length, lateral angle to the vertebral horizontal plane, eephalad angle to the vertebral sagittal plane of the trajectory and the horizontal distance from the insertion point to the lateral edge of the vertebral plate were measured. Differences of anatomic parameters for each gender, side and segment were analyzed. Results Differences of anatomic parameters on both sides of each segment had no statistical signifi- cance. At the ideal trajectory, the mean screw length was 37.56±2.41 mm at L1, 38.72±2.36 mm at L2, 39.51±2.51 mm at L3, 39.78± 2.87 mm at L4 and 38.83±2.74 mm at Ls. The mean screw diameters from Lj to L5 were 6.04±1.23 ram, 6.17±1.24 ram, 7.15±1.22 ram, 8.02±1.41 mm and 8.68±1.42 mm respectively. However, differences of ideal entry angle of L1 to L5 had no statistical significance. The mean lateral angle from L I to L5 were 8.46°±2.11°、9.37°±2.84°、9.62°±2.16°、9.53 °±1.98°、9.04°±1.97°, while the mean eephalad angle to the vertebral sagittal plane from L1 to L5 were 26.49°±4.97°、25.94°±4.56°、26.42°±4.42°、26.29°±3.48°、26.89°±3.69°. The mean distance from the insertion point to the lateral edge of the vertebral plate gradually increased from L1 to L5, which were 1.19±0.75 ram, 1.54±1.08 mm, 2.01±1.45mm, 3.49±1.52 ram, 4.47±1.32 mm respectively. The screw diameters of each segment for men were greater than those for women. Conclusion The common l

关 键 词：腰椎 骨螺丝 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学] R322[医药卫生—外科学]