螺钉植入后椎弓根横径膨胀的初步观察  

The expansion of transverse diameter of pedicle following screw implantation

作　　者：韦兴[1] 侯树勋[1] 史亚民[1] 商卫林[1] 

机构地区：[1]解放军第三○四医院骨科,北京100037

出　　处：《中华骨科杂志》2002年第10期627-629,共3页Chinese Journal of Orthopaedics

摘　　要：目的观察椎弓根植钉前后横径是否存在膨胀现象及其影响因素。方法采用新鲜尸体骨标本T2～L1共4具,均为女性,年龄25～50岁,平均41岁。将标本分解为单个椎体48个,共96个椎弓根。植钉前使用游标卡尺测量椎弓根横径,使用双能X线骨密度仪检测骨密度,随后对椎弓根进行骨密度(A)和直径比(椎弓根螺钉直径/椎弓根横径×100%,B)的3×3析因分组,共分为9组(A1B1,A1B2,A1B3,A2B1,A2B2,A2B3,A3B1,A3B2,A3B3)。按分组情况,使用同一类型螺钉,遵循统一标准植入螺钉,植钉后立即测量椎弓根横径。结果11例数据失效,包括6例椎弓根崩裂,其中A3B3组4例。有效实验数据为85个,经统计学分析:椎弓根植钉前后横径存在膨胀现象,且椎体骨密度和螺钉直径/椎弓根横径比均对椎弓根的膨胀率有显著影响(P<0.05),但两者之间无交互作用(P>0.05)。结论在行椎弓根系统内固定手术时,应考虑植钉后椎弓根的膨胀现象,以及椎弓根膨胀率与椎体骨密度、螺钉/椎弓根直径比之间的关系。椎弓根膨胀可能直接或间接引发相关临床症状。Objective To observe the expansion of transverse width of post screw-implantation in the pedicle and assess the effect of the relative diameter and BMD on the expansive rate. Methods There were 48 vertebral bodies, and 96 pedicles, obtained from 4 human cadaveric T2～L1 specimens (the mean age of 41 years). The BMD(A), pedicle width (B) and height were measured respectively. According to groups of BMD(A1:0.44～0.52 g/cm2;A2:0.52～0.70 g/cm2;A3:0.70～0.92 g/cm2 and the relative diameter(screw/pedicle)(B1:40%～55%;B2:55%～70%;B3:70%～85%), the tests were classified into 9 groups (A1B1?A1B2 ?A1B3?A2B1?A2B2?A2B3?A3B1?A3B2 and A3B3). The implantation procedure was carried out under the uniform standard. Results The number of valuable date was 85, while 11 dates were excluded, including 4 burst pedicles in A3B3 group. According to the statistical analysis, the pedicle width was expanded after implantation. The expansive rate of pedicle width was influenced significantly by the relative diameter and BMD(P< 0.05), however, there was no inter-relationship between the above mentioned two factors. Conclusion Since it may jeopardize spinal cord, expansion of pedicle width and related factors should be under consideration when pedicle fixation is applied.

关 键 词：螺钉植入 椎弓根横径膨胀 骨密度 X线测量 

分 类 号：R687.3[医药卫生—骨科学]