摘要
目的探讨窄小椎弓根的人口学因素及置钉并发症风险。方法选取2014年9月至2015年9月行胸腰椎薄层CT检查者312例。在CT横断位上测量各椎弓根横径、内、外侧皮质骨厚度、松质骨厚度、松质骨／皮质骨厚度比、e角及椎弓根钉道长径，分析窄小椎弓根发生率及节段分布；比较窄小椎弓根组与非窄小椎弓根组解剖学参数、窄小椎弓根受检组和非窄小椎弓根受检组年龄、性别、身高等人口学因素；评估窄小椎弓根的置钉风险。结果共测量3081个椎弓根，其中椎弓根横径＜5mm的窄小椎弓根74个，占2．40％（74／3081）；312例受检者中，存在窄小椎弓根者26例，占8．33％（26／312）。胸腰椎各节段窄小椎弓根比例分别为T10 0．32％（2／622）、T11 0．32％（2／617）、T12 0．98％（6／615）、L1 7．54％（46／610）、L2 2．92％（18／617）。窄小椎弓根组松质骨厚度及松质骨，皮质骨厚度比均小于非窄小椎弓根组，差异有统计学意义；而两组的内、外侧皮质骨厚度、e角及椎弓根钉道长径分别比较，差异均无统计学意义。窄小椎弓根受检组与非窄小椎弓根组平均年龄比较差异无统计学意义；窄小椎弓根受检组女性比例（84．6％，22／26）高于非窄小椎弓根组（49．7％，142／286），两者比较差异有统计学意义；窄小椎弓根受检组男、女性平均身高[（163．8±1．3）cm和（152．5±4．3）cm]分圳小于非窄小椎弓根受检组[（169．5±5．6）cm、（160．1±6．6）cm]，两者分别比较差异有统计学意义。共置入椎弓根螺钉256枚，其中黄钉所在椎弓根为窄小椎弓根32个，为非窄小椎弓根224个；窄小椎弓根组置钉穿透骨皮质发生率（84．6％，27／32）高于非窄小椎弓根组（14．7％，33／224），两者比较差异有统计学意义。结论胸腰椎窄小椎弓根最常见于L1节段，与椎弓根松质骨厚度狭窄相关。窄小椎弓根相对常见于矮小女性人群，椎弓根螺钉置入时穿透骨皮质风险较大。
Objective To explore the demographic factors and the risk of the pedicle screw insertion of the narrow pedi- cles. Methods Thoracolumbar spine thin-section CT image data of 312 adults from September 2014 to September 2015 were ana- lyzed. The pedicle width, medial and lateral cortical thickness, spongy bone thickness, spongy bone thickness/cortical thickness, e angle and screw path length of each pedicle were measured. The incidence and the distribution characteristics of the narrow pedi- cle were analyzed. Anatomic parameters and age, gender and stature were compared between the narrow pedicle group and non- narrow pedicle. The risk of the pedicle screw insertion of the narrow pedicle was assessed. Results Among the 3 081 pedicles, 74 narrow pedicles were determined as their pedicles width were less than 5 mm, and the proportion of narrow pedicle was 2.40%. Among the 312 subjects, 26 subjects were found having narrow pedicles, and the proportion of individuals with narrow pedMes in the population was 8.33% （26/312）. The incidences of narrow pedicle in thoracolumbar spine were T10 0.32%, T11 0.32%, T12 0.98%, L1 7.54%, L2 2.92%. The spongy bone thickness, spongy bone thickness/cortical thickness of narrow pedicle were lower than non-narrow pedicle. However, there were no significant differences of medial and lateral cortical thickness, e angle and screw path length between the narrow pedicle and non-narrow pedicle. Difference of the mean age between the two subjects groups had no statistical significance. The percentage of female in narrow pedicle subjects group was 84.6% （22/26）, which was higher than that in non-narrow pedicle subjects group （49.7%, 142/286）. The mean stature of the male and female of stenosis pedicle group subjects were 163.8± 1.3 cm and 152.5 ±4.3 cm, which were shorter than those of non-narrow subjects pedicle group （169.5±5.6 cm, 160.1±6.6 cm）. The percentage of the cortical bone breakthrough by the pedicle screws of narrow pedicle group was （84.6%, 27/32）, which was higher than that of non-narrow pedicle group （14.7%, 33/224）. Conclusion L~ is the most common segment of thoraeolumbar spine that narrow pedicle exist, which is the result of reduction of the spongy bone thickness. Narrow pedicle mostly appears in short stature fenmle. There is high risk of cortical bone breakthrough by insertion of the posterior pedicle screws in the narrow pedicle.
作者
何伟
钱宇
杨万雷
韩维奇
鲁轩源
金聪
李建磊
He Wei Qian Yu Yang Wanlei Han Weiqi Lu Xuanyuan Jin Cong Li Jianlei(Department of Orthopaedics, Shaoxing People＇s Hospital （Shaoxing Hospital of Zhejiang University）, Shaoxing 312000, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第1期36-43,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81572126）
浙汀省自然科学基金（LY15H060005）
浙江省自然科学青年基金（LQ16H160013）
绍兴市公益性技术应用研究计划（2014870076）
关键词
胸椎
腰椎
体层摄影术
X线计算机
解剖学
Thoracic vertebrae
Lumbar vertebrae
Tomography, X-ray computed
Anatomy
