肋横突结合区进钉途径研究

Study of costotransverse unit approach to thoracic

目的研究经肋横突结合区置钉固定脊柱的可行性和有效性。方法取4具成人防腐胸椎标本及相连的一段肋骨(长5～6cm),在椎体的一侧按常规方法置入椎弓根螺钉,对侧经肋横突结合区置入螺钉。对螺钉的位置和螺钉钉道的组成进行解剖学和影像学测量。结果经肋横突结合区置入的螺钉位于肋横突结合区和椎体内。螺钉经过横突,进入椎弓根占居椎弓根外侧的大部分和肋骨内侧部分,再进入椎体。正确放置的螺钉未进入椎间孔,不会损伤血管神经和胸膜。椎弓根螺钉误置率(21.4%)比肋横突结合区螺钉的(5.0%)要显著高。结论影像学和解剖学均证实,以横突中外1/3头侧处为进钉点,沿肋横突沟的方向进钉,可以在肋横突结合区安全地置入螺钉。

[Objective] To evaluate the feasibility and efficacy of costotransverse unit screw fixation of the thoracic spine. [Methods] Four embalmed human eadaverie thoracic spines were harvested with the medial 5～6 em of rib. The spines were instrumented on one side using eostotransverse unit screw technique and on the opposite side with standard pedicle screws. Both radiographic examination and anatomic dissections were undergone to verify the location of the screw. [Results] Costotransverse unit screws were placed within the pediele rib unit and vertebra. Screw penetrate the transverse processed and engaged the lateral aspect of the pediele and the medial aspect of rib without breaching of neural foramina, pleura and vascular structures. There were significant differences in misplace- ment rates between eostotransverse unit screws （21.4%） and pedicle screws （5.0%）. [Conclusion] Both radiographic-imaging and anatomic dissection proved the safety, of costotransverse unit screw application when placed correctly. Costotransverse unit screw placement is a safer approach in thoracic spine.