学龄期儿童胸椎经“椎弓根-肋骨”单元内固定的数字化测量  

Digital measurements of the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers

作　　者：和雨洁 王海燕 李志军 李筱贺[1] 蔡永强 戴丽娜 许阳阳[3] 王一丹 徐雪彬 He Yujie;Wang Haiyan;Li Zhijun;Li Xiaohe;Cai Yongqiang;Dai Lina;Xu Yangyang;Wang Yidan;Xu Xuebin(Department of Anatomy of Basic Medical School,Inner Mongolia Medical University,Hohhot 010059,Inner Mongolia Autonomous Region,China;Center of Digital Medicine,Inner Mongolia Medical University,Hohhot 010059,Inner Mongolia Autonomous Region,China;Graduate School,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学基础医学院人体解剖学教研室,内蒙古自治区呼和浩特市010059 [2]内蒙古医科大学数字医学中心,内蒙古自治区呼和浩特市010059 [3]内蒙古医科大学研究生院,内蒙古自治区呼和浩特市010010

出　　处：《中国组织工程研究》2020年第6期869-876,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81560348,81860383)，项目负责人：李志军;国家自然科学基金(81460330)，项目负责人：李筱贺;内蒙古财政厅科技引导项目(2017)，项目负责人：李筱贺;内蒙古教育厅青年科技英才项目(njyt-15-b05)，项目负责人：李筱贺;内蒙自治区科技计划项目(2016)，项目负责人：李筱贺;内蒙古自治区科技创新引导项目(2017)，项目负责人：李筱贺;内蒙古自治区自然科学基金(2016ms08131)，项目负责人：李筱贺;内蒙古人社厅归国留学人员基金，项目负责人：李筱贺;内蒙古医科大学科技百万计划基金(YKD2017KJBW012)，项目负责人：王海燕~~

摘　　要：背景:经椎弓根螺钉内固定已广泛应用于腰椎,且在胸椎中固定的应用已逐渐被接受。但由于考虑到上胸椎椎弓根狭窄,特别是在T3-T9之间,椎弓根置钉几乎都会穿破皮质伤及邻近重要结构的风险,为避免出现严重的并发症,有学者提出经肋横突关节和肋椎关节至椎体的椎弓根外入路,之后又有人设计了类似的进钉方法,提供足够不穿出肋骨的安全路径。目前,现有的研究多集中于成人中、上胸椎。目的:测量学龄期儿童胸椎经椎弓根-肋骨单元螺钉内固定的相关解剖参数,探讨其在不同年龄段、不同性别之间的发育规律和形态特征,为临床提供理论依据。方法:选择7-12岁学龄期儿童胸椎67例,无骨质破坏、肿瘤、畸形、退变、骨折等脊柱疾患及既往无脊柱相关手术病史,行螺旋CT扫描后三维重建,观测椎弓根-肋骨单元的形态结构,测量其横径、长度、内倾角及经椎弓根-肋骨单元置钉安全角度范围并进行统计分析,探讨其在解剖学上置钉的可行性。所有儿童的监护人对试验方案均知情同意,且得到医院伦理委员会批准。结果与结论:①胸椎"椎弓根-肋骨"单元横径随年龄增加而增大,随椎序的增加呈先减少后增加的趋势,同年龄组内男性大于女性;②经"椎弓根-肋骨"单元钉道长度在不同年龄组中差异均有显著性意义(P<0.05),随年龄的增长出现明显增高趋势,随椎序的增加呈先增后减趋势;③经"椎弓根-肋骨"单元置钉最小和最大内倾角得出安全角度范围为18°-25°,其中置钉安全范围最大位于T1,其次为T10,最小位于T4和T5;④由此可见,胸椎经椎弓根-肋骨单元置钉安全角度范围儿童较成人窄,在行椎弓根-肋骨单元置钉时若参照成人的标准可能会引起严重的神经血管损伤,需根据术前CT结果进行个体化置钉。BACKGROUND: Pedicle screw internal fixation has been widely used in the lumbar spine, and fixed application in thoracic vertebra has gradually been accepted. Considering the narrow thoracic pedicle, especially at T3-T9, pedicle screw always punctures the cortex and important adjacent structures. To avoid serious complications, researchers developed the external pedicle approach from the costal transverse process joint and the costal vertebra joint to the vertebral body, and then others designed a similar screw entry method, which can provide enough safe paths as long as the ribs are not penetrated. At present, the existing studies mainly focus on the upper and middle thoracic vertebrae in adults. OBJECTIVE: To measure the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers, and to explore their developmental regularity and morphological characteristics at different age groups and sexes, so as to provide theoretical basis for clinical practice. METHODS: Sixty-seven preschoolers aged 7-12 years old without bone destruction, tumor, deformity, degeneration or fractures at the spine and no history of spine related surgery were selected. Three-dimensional reconstruction was conducted after spiral CT scanning. The morphological structure of pedicle-rib unit was observed. The transverse diameter, length, inclination angle and safety angle range of pedicle-rib unit screw were measured and analyzed statistically to investigate the feasibility of screw on anatomy. All guardians of the children signed the informed consents, and the study was approved by the hospital ethical committee. RESULTS AND CONCLUSION: (1) The transverse diameter of the thoracic pedicle-rib unit was increased with age, and decreased first and then increased with the increase of vertebral sequence. The transverse diameter in males was larger than in females at the same age. (2) The length of pedicle-rib screw channel was significantly different in different age groups (P < 0.05), which showed a significant incr

关 键 词：胸椎 “椎弓根-肋骨”单元 发育特征 学龄期儿童 个体化置钉 内固定 国家自然科学基金 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]