L5/S1轴向固定经皮椎弓根单向锁定研究

Experimental study for the L5/S1 axial fixed and one-way locking via percutaneous pedicle approach

目的 通过对直肠后间隙入路L5/S1椎间隙轴向固定经皮椎弓根单向锁定的实验研究探讨其可行性和安全性.方法 选取成年尸体标本8具,轴向固定螺钉和单向锁定螺钉及锁定瞄准器等,模拟直肠后间隙入路L5/S1椎间隙轴向固定经皮椎弓根单向锁定手术.测量矢状面轴向固定螺钉与单向锁定螺钉相交头倾角以及轴向固定螺钉在椎体中的位置.水平面轴向固定螺钉的矢状面与单向锁定螺钉相交外展角以及轴向固定螺钉在椎体中的位置.观察经皮椎弓根单向锁定螺钉通道对周围毗邻重要组织结构有无损伤.结果 在矢状面轴向固定螺钉与单向锁定螺钉的头倾角平行且均为90.,轴向固定螺钉与椎体后纵韧带平行,多位于椎体中心.在水平面轴向固定螺钉的矢状面与单向锁定螺钉相交的外展角为45.9＆#176;～79.0＆#176;,平均68.9＆#176;,轴向固定螺钉居于椎体中心.单向锁定螺钉通道在L5多穿行横突、进入椎弓根峡部内与椎体中心轴向固定螺钉相交固定.在S1穿行髂棘后,再从关节突外缘进入椎弓根峡部内与椎体中心轴向固定螺钉相交固定.单向锁定螺钉通道与周围毗邻组织无重要结构损伤.结论 L5/S1轴向固定经皮椎弓根单向锁定只要单向锁定经过椎弓根峡部中心与椎体中心相交是安全可行的.

Objective To investigate the feasibility and safety of the test and anatomic measurement of L5/S1 axial fixed via the way of after rectum gap unite the way of percutaneous pedicle and one-way locking.Methods Choose 8 specimens of adult bodies,axial fixation screws and one-way locking screws,etc.To simulate the operation of L5/S1 intervertebral axial fixed via after rectum clearance unite the way of percutaneous pedicle and one-way locking.Measuring the head tilt angle of sagittal axial fixation screw fellowship and one-way locking screw,and the location of the one-way locking channel and axial fixation screw in the pedicle and the vertebral bodies.Measuring the outreach angle of the axial fixed screw with the one-way locking screw in horizontal plane,and the location of the one-way locking channel and axial fixation screw in the pedicle and the vertebral bodies.Observe the damage of percutaneous pedicle approach and one-way locking channel on the adjacent important organization.Results This experiment goes well.The head angle of L5/S1 vertebral axial fixed screw with one-way locking screw is 90＆#176; in the sagittal plane.Most of the one-way locking screw channel through the center of the pedicle isthmus and most of the axial fixed screw located in the heart of the vertebral bodies.The outrench angle of L5/S1 vertebral axial fixed screw with one-way locking screw is 45.9＆#176;-79.0＆#176;,and an average of 68.9＆#176; in the horizontal plane.Most of the one-way locking screw channel through the center of the pedicle isthmus and most of the axial fixed screw located in the heart of the vertebral bodies too.The channels of one-way locking screw through the L5 transverse process and enter the pedicle isthmus and then fixed the axial fixed screw which located in the center of the vertebral body.The channels of one-way locking screw through the Sl iliac spine and then from the edge of the articular process into the pedicle isthmus and then fixed the axial fixed screw which located in the center of the vertebral body.The one-way locking screw channel have no damage to the adjacent important structure and tissue.Conclusion It is safe and feasible that axial fixed L5/S1 via unite the way of percutaneous pedicle and one-way locking as long as one-way locking screw through the intersection of pedicle isthmus and the central axis of vertebral body.