胸腰椎乳副突间凹进钉点的解剖学研究与应用

Surgical Anatomical Study of Insert Point of the Fossa between the Mamillary Process and Accessory Process

目的 :探讨胸、腰椎乳副突间凹点作为椎弓根准确置钉的有形解剖学进钉点标志。方法 :(1)对 40具成人干燥标本 (T11～L5)上的乳突、副突及乳副突间凹的存在率 ,凹点与椎弓根中心及椎上、椎下切迹的关系进行观测。 (2 )临床应用CT扫描观测置钉效果。结果 :发现乳副突间凹的总存在率为 98.5 7% ,T11～L4 为 10 0 % ,L5为 90 %。在L5中无副突者占 10 % ,却在横突与乳突间且呈典型的“U”形凹特征。该法进钉 5 6例 2 2 4钉准确率 10 0 %。结论 :乳副突间凹有形可见、结构恒定 ,具有解剖学特征 ,术中寻找方便 ,又无需显露横突及关节突关节 ,是一种安全、准确。

Objective: To study the fossa between the mamillary process and the accessory process of the thoracolumbar spine as a new marked point of insertion of pedicle screw. Mothods: 40 dry thoracolumbar specimens were obtained for the study. Anatomical evaluation on determination of the fossa between the mamillary process and the accessory process and between the fossa point with the pedicle center.Results: The exist rate of the fossa was 100% in T 11 ～L 4,90% in L 5, the rest 10%, there was a “u” fossa between the mamillary process and the accessory process. 56 cases were operated and 224 transpedcular screws placed, the accurate rate of the screw position was 100%. Conclusion: The fossa between the mamillary process and the accessory process was projection marked point, that is from it through center of the pedicle to the body. It was easily exposed and identified in the operation, with no need to expased the transverse process. This method is easy to operate and ensures it safe that transpedicular screw be precisely inserted without roentgenoscopy.