上中胸椎经椎弓根-肋骨单元途径置钉的安全性及稳定性研究  

Study on the safety and stability of upper-middle thoracic pedicle screw insertion through pedicle rib unit approach

作　　者：盛红枫 徐卫星[1] 卢笛[1] 丁伟国[1] 许新伟[1] 

机构地区：[1]浙江省立同德医院,浙江杭州310012

出　　处：《中医正骨》2017年第2期1-5,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：全国名老中医药专家传承工作室建设项目[国中医药人教发2014(20)号]

摘　　要：目的:探讨上中胸椎经椎弓根-肋骨单元(pedicle rib unit,PRU)途径置钉的安全性及稳定性。方法:对10名无脊柱病变的志愿者进行脊柱T_1~T_8。节段CT扫描,在获得的CT图像上测定各节段的PRU途径置钉安全角度范围、椎弓根横径、PRU横径、椎弓根纵径、PRU纵径及PRU重叠纵径。取4具尸体脊柱标本(T_1~T_8节段),对应肋骨保留10 cm左右。随机于每个脊柱标本的两侧分别经经典椎弓根途径和PRU途径置入椎弓根螺钉,两侧螺钉的直径及长度分别为对应的椎弓根横径的70%和各自钉道最长值的70%。应用Instron 5569电子万能试验机测定螺钉的抗拔出力。结果:10名志愿者T_1~T_8途经PRU途径置钉的安全角度范围分别为19.71°±1.64°、19.42°±1.88°、17.17°±0.67°、17.22°±1.170、19.36°±1.31°、18.67°±1.58°、18.82°±2.60°、18.72°±1.58°。10名志愿者T_1~T_8椎弓根横径均小于同节段的PRU横径[(8.78±0.05)mm,(18.23±2.46)mm,t=18.192,P=0.013;(7.59±0.08)mm,(16.80±1.31)mm,t=20.175,P=0.002;(6.29±0.07)mm,(15.12±1.22)mm,t=20.271,P=0.004;(5.50±0.05)mm,(14.43±1.00)mm,t=27.403,P=0.004;(5.52±0.06)mm,(14.02±0.85)mm,t=20.312,P=0.001;(5.90±0.06)mm,(14.19±1.12)mm,t=16.772,P=0.047;(6.31±0.07)mm,(14.77±1.31)mm,t=14.229,P=0.017;(6.64±0.03)mm,(15.53±1.90)mm,t=13.000,P=0.048)。10名志愿者T_1~T_8椎弓根纵径、PRU纵径、PRU重叠纵径三者之间总体比较差异均有统计学意义[(8.04±1.01)mm,(11.05±1.83)mm,(6.37±0.68)mm,F=236.422,P=0.000;(10.72±0.99)mm,(13.09±1.30)mm,(7.46±1.12)mm,F=60.570,P=0.000;(11.34±0.99)mm,(13.45±0.92)mm,(8.99±0.62)mm,F=67.560,P=0.000;(10.67±0.91)mm,(12.49±0.94)mm,(7.94±0.84)mm,F=64.965,P=0.000;(10.34±0.94)mm,(11.96±0.95)mm,(7.96±0.96)mm,F=44.926,P=0.000;(11.33±0.96)mm,(12.36±0.62)mm,(7.72±0.88)mm,F=85.197,P=0.000;(11.30±0.82)mm,(12.16±0.71)mm,(8.34±0.47)mm,F=92.350,P=0.000;(11.39±0.78)mm,(13.71±1.51)mm,(9.34±0.93)mm,F=37.867,P=0.000)。T_1~T_8椎弓根纵径和PRU纵径均大于PRU重�Objective：To explore the safety and stability of upper- middle thoracic pedicle screw insertion through pedicle rib unit（PRU） approach.Methods：Ten volunteers with no spinal disease received CT scanning at T1-8 vertebral segments,and safe angle range of pedicle screw insertion through PRU approach,transverse diameter of pedicle of vertebral arch,transverse diameter of PRU,longitudinal diameter of pedicle of vertebral arch,longitudinal diameter of PRU and PRU overlapped longitudinal diameter of all segments were measured on the obtained CT images.Four cadaveric T_（1-8） specimens were selected and 10 cm long ribs were reserved.The pedicle screws were randomly inserted into both sides of each spine specimen through classical pedicle of vertebral arch approach and PRU approach respectively.The diameters of the screws were 70%of transverse diameter of corresponding pedicles of vertebral arch and the lengths of the screws were70%of the maximal values of corresponding screw path lengths.The pullout strength of the screws were measured by using instron 5569 electronic universal testing machine.Results：The safe angle ranges of pedicle screw insertion through PRU approach were 19.71 ＋/- 1.64,19.42 ＋/-1.88,17.17 ＋/-0.67,17.22 ＋/-1.17,19.36 ＋/-1.31,18.67 ＋/-1.58,18.82 ＋/-2.60,18.72 ＋/-1.58 degrees respectively at T1- 8 vertebral segments of 10 volunteers.The transverse diameters of pedicle of vertebral arch were less than the transverse diameter of PRU at T_（1-8） vertebral segments of the 10 volunteers（8.78 ＋/-0.05 vs 18.23 ＋/-2.46 mm;t=18.192,P = 0.013;7.59 ＋/-0.08 vs16.80 ＋/-1.31 mm,t=20.175,P =0.002;6.29＋/-0.07 vs 15.12 ＋/-1.22 mm,t=20.271,P =0.004;5.50＋/-0.05 vs 14.43 ＋/-1.00 mm,t=21.403,P=0.004;5.52 ＋/-0.06 vs 14.02 ＋/-0.85 mm,t=20.312,P = 0.001;5.90 ＋/-0.06 vs 14.19 ＋/-1.12 mm,t=16.112,P=0.041;6.31 ＋/-0.07 vs 14.77＋/-1.31 mm,t =14.229 P =0.017;6.64 ＋/-0.03 vs 15.53＋/-1.90 mm,t= 13.000,P =0.048）.In general,there was statistical difference between longi

关 键 词：胸椎 椎弓根 椎弓根-肋骨单元 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]