东北地区成人腰椎棘突倾斜角度数字解剖学：为椎弓根螺钉置入的参考标准

Digital anatomy of lumbar spinous process tilt angle of adults in northeast China: prodinding reference for pedicle screw insertion

背景:经后路椎弓根螺钉钉棒系统内固定是各种腰椎手术的主要术式,其成功的关键是椎弓根螺钉的准确置入,但棘突是位置表浅的解剖标志,在术中有较大的参考价值。目的:分析东北地区成人腰椎棘突倾斜情况,并进行解剖分级,同时讨论其作为椎弓根螺钉内固定手术局部解剖学定位标志参考的可行性。方法:对97例东北地区成人腰椎棘突倾斜角度进行测量,并根据倾斜角度进行分型;对各研究对象进行模拟手术,确定椎弓根螺钉的最佳置钉角度,测量椎弓根螺钉与棘突、标准矢状面夹角,对二者进行差异性比较。结果与结论:(1)腰椎各型分布如下:型占75.1%,Ⅱ型占20.9%,Ⅲ型占2.3%,Ⅳ型占1.7%,经比较椎弓根螺钉与棘突、标准矢状面夹角无明显差异;(2)结果说明,腰椎棘突倾斜角度存在不同程度变异,腰椎手术前应通过相关检查明确变异情况,棘突可做为椎弓根螺钉置钉时倾斜角度的参考。

BACKGROUND： Posterior lumbar fusion using pedicle screw-rod system fixation is the main surgical method for various lumbar diseases, and the accuracy of pedicle screw insertion is the key to success. Spinous processes are superficial in position, which serve as a anatomical landmark providing significant reference.OBJECTIVE： To analyze the anatomical classification of spinous process tilt of adult in northeast China, and to discuss the feasibility of it as the reference of anatomical landmark in pedicle screw fixation.METHODS： The tilt angle of spinous processes of 97 adults in northeast China was measured, and spinous processes of lumbar vertebrae were then classified. All subjects underwent simulative operation to determine the optimal insertion angle, measure the angle between pedicle screw and the spinous process, or standard sagittal plane for comparative analysis. RESULTS AND CONCLUSION： （1） The results were as follows： the distribution of type I was 75.1%, and 20.9% of type Ⅱ, 2.3% of type Ⅲ, 1.7% of type Ⅳ. Moreover, there were no significant differences in the angle between pedicle screw and the spinous process, or standard sagittal plane. （3） These findings suggest that lumbar spine angle varies in different individuals, which shouldbe defined through relative examinations. Additionally, spinous process can be a reference in pedicle screw inserting operation.