腰椎棘突上缘根部与椎弓根关系的解剖学和影像学定位

Relationship between superior margin root of spinous process and vertebral pedicle in lumbar spine:Anatomy study and imageology localization

目的：以影像学定位探讨腰椎棘突上缘根部与椎弓根的解剖关系，提供相关数据为椎弓根穿钉确定准确的解剖定位点。方法：实验于2007-05/12在重庆医科大学解剖实验室和重庆九龙坡区第三人民医院放射科进行。①测量20具干燥胸腰椎骨标本L1-5节段之棘突上缘根部至椎弓根上缘、下缘及中轴线的距离。②测量60个正常成人腰椎X射线平片及40个正常成人腰椎CT片L1-5节段之棘突上缘根部至椎弓根上缘、下缘及中轴线的距离，对两者的平均值进行比较。③据测量数据结果，以棘突为定位标志，选取合适椎弓根进钉点，在5具正常成人新鲜尸体上做模拟手术。结果：①获得了相关解剖学数据，L1-4棘突上缘根部逐渐接近椎弓根中轴线。L4棘突上缘根部与椎弓根中轴线接近，几近平齐；L5棘突上缘根部多在椎弓根中轴线上方5mm左右范围内。②成人各椎骨棘突上缘根部平面至椎弓根上缘平面、下缘平面及中轴线平面的垂直距离，X射线平片和CT片测量结果比较差异无显著性意义（P〉0.05）。③以所得数据设计螺钉入点，实验中60个螺钉全部穿钉成功，无一例穿透椎弓根皮质。结论：①L1-5的棘突上缘根部都位于椎弓根上、下平面范围内，X射线平片与CT测量值无明显差别，具有较为恒定的解剖位置关系，为椎弓根穿钉置入提供了参考数据。

AIM： To study the anatomic relationship between the superior margin root of spinous process and vertebral pedicle, so as to provide related data to define anatomic landmarks for placement of screw into pedicle, METHODS： The experiment was performed at Anatomy Laboratory of Chongqing Medical University and Department of Radiology, Jiulongpo Third People＇s Hospital from May to December 2007. （1）Twenty dry thoracolumbar （L1-5） specimens were selected, and the distance from superior margin root of spinous process to superior, inferior margin and axis of vertebral pedicle were measured, （2）Lumbar spine plain tomography of sixty normal adult and CT of forty L1-5 were obtained, and the distance between superior margin of spinous processes pedicle and pedicle of vertebral arch superior margin, or inferior margin and axis were measured. The two mean values were compared. （3）With spinous process as location marks, entrance point of pedicle screw were selected, and simulated operation was conducted in five fresh cadavers, RESULTS：（1）Related anatomic data was obtained and L1-4 superior margin of spinous process pedicle approached axis of vertebral pedicle. Most L5 superior margin root of spinous process located about 5 mm above axis of vertebral pedicle. （2）There were no significant differences between plain tomography and CT films （P 〉 0.05）. （3）The entrance point of screw was designed based on the obtained data. Sixty screws were all inserted into pedicles successfully, CONCLUSION： L1-5 superior margin root of spinous process locates in superior and inferior planes of vertebral pedicle with stable anatomic relationship; in addition, there are no significant differences between plain tomography and CT films It provides anatomic data for pedicular operation.