以椎板应力线及关节面为参考标志的改良椎弓根置钉方法的应用研究  

Applied research about modified method of vertebral plate stress line and articular facet as a reference mark of pedicle screw insertion

作　　者：姜传杰[1] 杨永军[1] 周纪平[1] 杨凯[1] 吴瑞[1] 谭远超[1] 

机构地区：[1]山东省文登整骨医院,山东文登264400

出　　处：《中国临床解剖学杂志》2016年第5期490-494,共5页Chinese Journal of Clinical Anatomy

基　　金：山东省2012年科学技术发展项目(2012YD19004)

摘　　要：目的探讨确定脊柱经椎弓根置钉的改良方法。方法以椎板应力线及关节面为参考标志的改良置钉方法及传统置钉方法对205例脊柱疾患患者进行手术置钉,A组进钉点:按传统进钉方法。B组改良置钉方法:寻找椎板应力线骨嵴及关节面的位置,以此为参考点。应用术中及术后X线、CT检查及术中神经根剥离子触摸检查置钉准确性,计算术中一次性置钉的成功率,比较传统入钉法与改良入钉法的置钉成功率。结果应用传统置钉方法与改良置钉方法置钉成功率在颈椎手术中分别达到78.1%和95.5%(P=0.002),在胸椎手术中达到82.4%和95.9%(P<0.001),在腰椎手术中达到80.3%和97.0%(P<0.001),总计成功率为80.7%和96.5%(P<0.001)。两组差异有明显统计学意义。结论应用椎板应力线及关节面为参考标志的椎弓根置钉方法可以作为颈椎、胸椎及腰椎传统置钉方法的改良方法,有较高的置钉成功率。应力线骨嵴及关节面分别代表椎体的应力传导情况,按此参考标志进行置钉,可实现椎弓根置钉的个体化,有较大的应用价值。Objective To study the modified method of pedicle screw insertion. Methods 205 cases of spinal disorders, including thoracic, cervical and lumbar disorders, were randomly divided into two groups and underwent surgery to insert pedicle screw. Pedicle screw insertion method of group A was determined by the traditional method and group B was by the modified method, using the vertebral plate stress line and articular facet as a reference mark. Intraoperative and postoperative X-ray, CT and intraoperative nerve dissector touch inspection were adopted to determine the insertion accuracy. One-time success rate of pedicle screw insertion was calculated to compare which determination method was more successful. Results Success rates of traditional method and the modified method were respectively 80.7% and 96.5%（P〈0.001）, among which 78.1% and 95.5% （P=0.002） were in cervical spine surgery, 82.4% and 95.9% in thoracic surgery （P〈0.001）, 80.3% and 97.0% in lumbar spine surgery （P〈0.001）. Conclusion The modified method using vertebral plate stress line and articular facet as a reference mark of pedicle screw insertion has a higher success rate of insertion. As stress line and articular facet respectively representing the stress conduction of the vertebral body, the modified pedicle insertion method showed a great application value and could realize individualized pedicle screw insertion.

关 键 词：应力线 关节面 置钉 参考标志 

分 类 号：R687.3[医药卫生—骨科学]