改进第一骶椎椎弓根螺钉进入法的解剖学研究与临床应用

Anatomical Research of an Improved Approach of S 1 Sacrum Transpedicle Screw and Its Clinical Application

目的 改进Ｓ１ 椎弓根螺钉的进入方法。方法 选取２０ 具完整成人骶骨标本，测量Ｓ１下列指标：椎弓根尾偏角、椎弓根高度、椎弓根后投影、螺钉通道长度（ＬＳＰ） 及螺钉通道（ＳＰ）内偏角。同时观察椎弓根横断面、矢状面及骶骨翼轴线面骨小梁的分布情况。在测量的基础上，确定改进进钉点及其角度。临床应用５３ 例，男２１ 例，女３２ 例；年龄２５ ～６５ 岁，平均４４．４ 岁。按Ｍｅｙｅｒｄｉｎｇ 分度方法，Ⅰ度２１ 例，Ⅱ度２７ 例，Ⅲ度５ 例。结果 Ｓ１ 进钉点改在冠状位小关节上为小关节面下缘水平线与小关节突外缘交点；斜位、矢状位小关节上为小关节面下缘水平线与小关节突外缘向外直移１ ～３ ｍ ｍ 的垂直线交点处，置入方向为内偏２５°～３０°，尾偏２５°～３０°。５３ 例共应用１０６ 枚Ｓ１ 螺钉，其中１０４ 枚一次性准确通过椎弓根，随访７ ～６３ 个月，按Ｓｔｅｆｆｅｅ 标准，Ｖ 级４８ 例，Ⅳ级５ 例。结论 改进后的Ｓ１ 螺钉进入方法，明显改善了手术操作，增加了安全性。

Objective\ To improve the insertion technique of sacrum transpedicle screw. Methods Twenty human adult sacrum specimens had been used to study the following parameters:1)caudal angle,height,posterior shadow casting of the vertebral arch pedicle respectively. 2) the length of screw passage(LSP),the screw passage medicle angle. 3)trabecula distribution on cross sectioon,sagittal plane,sacrum wing axis plane of vertebral arch pedicle. Based on the measurements, screw insertion site and angle were determined. Results\ The clinical application in 53 cases indicated:1) insertion site is better at the exterior aspect of the horizontal line of intervertebral facet joints in coronal section, while in oblique and sagittal plane, 1-3 mm further outward. 2)insertion angle should deviate 25-30 degrees medially and 25-30 degrees caudally.Among the 106 screws clinically applied to pass through the vertebral arch pedicle,104 were successful at the first attempt.A follow up from 7 to 63 months showed that there were 48 cases met V grade, 5 cases met Ⅳgrade,according to Steffee standard. Conclusion\ Improvement of the insertion angle and site of sacrum transpedicle screw enables the safty of operation.