健康国人腰椎椎弓根轴线与关节突最高点连线矢状面成角的三维重建测量

The relationship between the sagital srew angle of the lumbar pedicle of vertebral arch and the line of the top point on the facet joint

目的评估健康国人腰椎椎弓根轴线与该椎体上下关节突最高点连线矢状面成角。方法宝石CT扫描全腰椎患者数据中，筛选骨质及序列正常患者共132例，其中男78例，女54例；根据年龄，20～29岁共31例，30～39岁44例，40～50岁57例。提取数据构建数字三维模型；基于此模型，寻找椎弓根理论轴线a，该椎体上下关节突最高点连线b，通过棘突定位标准矢状面，将a、b投影至矢状面获得a’、b’并测量其夹角。 结果L1～L5椎弓根轴线与上下关节突最高点连线的夹角依次为（85.13±4.18）°、（88.20±4.24）°、（83.56±3.62）°、（82.72±5.88）°、（73.42±7.83）°；L1～L5数据在不同性别组间差异（P1＝0.038，P2＝0.041，P3＝0.036，P4＝0.070，P5＝0.104），年龄组间差异（P’1＝0.041，P’2＝0.044，P’3＝0.036，P’4＝0.058，P’5＝0.078）。 结论腰椎椎弓根螺钉技术的关键之一为矢状面成角，本研究证实，以上下关节突连线作为解剖参照估计术中置钉角度，具有较好的实用性和可靠性，了解这一解剖特点，有助于准确置入椎弓根螺钉。

ObjectiveTo investigate the relationship between the sagital srew angle of the lumbar pedicle of vertebral arch and the line of the top point on the facet joint. MethodsA total of 132 patients with normal bone and sequence were scanned by gem CT scan. There were 78 males and 54 females. According to age, there were 31 cases between 20 and 29, 44 cases between 30 and 39, and 57 cases between 40 and 50. Data were extracted and digital three-dimensional models were constructed. Based on this model, the theoretical axis a of the pedicle of vertebral arch, the highest point of the upper and lower facet joints of the vertebral body, was obtained. The standard sagittal plane was obtained through the spinous process, and line a and line b were projected to the sagittal plane and the included angles were measured. ResultsThe angle between the axis of the L1-L5 pedicle and the highest point of the upper and lower facet joint was （85.13±4.18）°, （88.20±4.24）°, （83.56±3.62）°, （82.72±5.88）°, and （73.42±7.83）° respectively. The L1-L5 data between different genders were P1=0.038, P2=0.041, P3=0.036, P4=0.070, P5=0.104, between different age groups were P’1=0.041, P’2=0.044, P’3=0.036, P’4=0.058, P’5=0.078.ConclusionOne of the key techniques of lumbar pedicle screw fixation is sagittal angulation. This study confirmed that the above joint line was used as anatomic reference to estimate the nail angle of the operation. It has good practicability and reliability. Understanding this anatomical feature is helpful for accurate placement of pedicle screws.