摘要
目的探讨腰骶移行椎椎弓根螺钉的进钉方法，为临床应用提供形态学依据。方法共91具腰骶移行椎标本。生前资料完整者59具，男54具，女5具；平均年龄（41．2±16．7）岁，身高（162．4±713）cm。对椎弓根、上关节突、人字嵴、横突后部突起及“V”形槽进行观测，确定进钉点、进钉角度及深度。结果按照Castellvi分型法，移行椎ⅡA型13具（左6具，右7具），ⅡB型10具，ⅢA型7具（左2具，右5具），ⅢB型60具，Ⅳ型1具。移行椎人字嵴均不明显，横突后结节突起与上关节突形成的“V”形槽均较明显。以移行椎上关节突关节面下缘水平线与“V”形槽最凹陷处交点作为移行椎椎弓根螺钉的进钉点，该点至椎弓根上缘距离，左（8．6±1．2）mm，右（8.3±1．2）mm；与矢状面呈20。时钉道至侧隐窝外侧壁距离，左（7．5±3．1）mm，右（7．2±2．7）mm；进钉角度，左21.3°±4．1°，右21．0°±4．6。；进钉深度，左（39．1±2．8）mm，右（39．1±2．7）mm。结论腰骶移行椎后部横突变异，人字嵴结构不明显，以此作为进钉定位标志不可靠，而“V”形槽恒定存在，可以将上关节突关节面下缘的水平线与“V”形槽的最凹陷处的交点作为椎弓根螺钉的进钉点。
Objective To study the anatomical basis for pedicle screw insertion of the lumbosacral transitional vertebrae. Methods Ninty-one dry lumbosacral transitional vertebrae specimen were anatomical evaluated, and 59 eases of all had intact material in birth （54 males, 5 females）, with an average age of （41.2±16.7） years, and an average height of （162.4±7.3） cm. The position of the ＂V＂ shape incisure and its relationship with the superior incisure of the pedicle were measured. The distance between the lateral wall of its recess and pedicle screw, the depth of the pedicle screw and the lateral obliquity angle for the pedicle screw insertion were also done. Results According to Castellvi classification, there were 13 lumbosacral transitional vertebrae for ⅡA （left 6, right 7）, 10 cases for ⅡB, 7 cases for IliA（left 2, right 5）, 60 cases for ⅢB, 1 case for IV. The ＂A ＂ shape crest were observed unclearly in all specimen, but the ＂V＂ shape incisure between the posterior eminence of the transverse process and the superior articular process were all observed obviously. The intersection point of lines through the lowest position of the ＂V＂ shape incisure and the inferior border of articular cartilage of superior articular process acted as the pedicle screw insertion point of the lumbosacral transitional vertebrae. The distance from the insertion point to the superior incisure of the pedicle was （8.6±1.2） mm in left, （8.3±1.2） mm in fight. The distance between the lateral wall of its recess and pedicle screw was （7.5±3.1） mm in left, （7.2±2.7） mm in fight when the lateral obliquely angle at the insertion point was 20°. The lateral obliquely angle at the insertion point was 21.3±4.1° in left, 21.0°± 4.6° in fight. The depth of the pedicle screw was （39.1±2.8） mm in left, （39.1±2.7） mm in right. Conclusion Usage a new landmark of the ＂V＂ shape incisures for pedicle screw insertion through posterior approach can result in a very simple, easily way that leads to a very high success rate of pedicle screw insertion and a relatively low risk of neurological damage.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第1期17-21,共5页
Chinese Journal of Orthopaedics
基金
北京市教委资助项目（KM200610025019）
关键词
腰椎
骶骨
解剖学
局部
Lumbar vertebrae
Sacrum
Anatomy, regional
