下颈椎对侧椎板切线作为椎弓根置钉角度参考标志的可靠性分析

Reliability of the Contralateral Lamina Tangent Line of the Subaxial Cervical Vertebra as the Orientation for Pedicle Screw Insertion

目的:评估下颈椎对侧椎板切线作为椎弓根置钉角度参考标志的可靠性,并测量椎弓根宽度,为选择置入的椎弓根钉直径作参考。方法:测量广州中医药大学第一附属医院105位患者C3~C7椎体椎弓根角(椎弓根轴线相对于椎体矢状面的夹角)、椎板角(椎板切线相对于椎体矢状面的夹角)及椎弓根宽度,观察椎弓根角与对侧椎板角的相关性,统计椎弓根宽度。结果:共测量了523个椎体(排除了2个CT图像不佳的女性椎体),其中男性C3的左侧椎弓根角平均值为47.37°,右侧椎板角平均值为47.35°,右侧椎弓根角平均值为48.20°,左侧椎板角平均值为48.21°。所有C3~C5椎体椎弓根角与对侧椎板角的角度差异一般小于1°(R2>0.9,P<0.001),存在明显相关性(男性R2=0.638,女性R2=0.572),男女之间无明显差异。C6~C7椎弓根角与对侧椎板角之间无明显相关性(男性R2=0.307,女性R2=0.226)。男女椎弓根宽度的最小值分别为0.29 cm(男性)和0.27 cm(女性)。结论:C3~C5椎弓根轴线与对侧椎板切线呈近似平行关系,对侧椎板可以从矢状面角度为椎弓根螺钉置入角度提供参考。但在C6和C7节段,不建议将对侧椎板作为椎弓根置钉的参考。椎弓根螺钉的安全直径分别在0.29 cm(男性)及0.27 cm(女性)以内。

Objective:To evaluate the reliability of the contralateral lamina tangent line of the subaxial cervical vertebra as the orientation for pedicle screw insertion,and to measure the pedicle width as a reference for the diameter of the pedicle screw.Methods:The pedicle Angle,vertebral lamina Angle and pedicle width of the C3~C7 vertebral bodies were measured in 105 patients from the first affiliated hospital of Guangzhou university of Chinese medicine in order to observe the correlation between the pedicle angle which was the angle between the axis of the pedicle and the sagittal plane of the vertebral body and the lamina angle which was the angle between the lamina tangent line and the sagittal plane of the vertebral body.The pedicle width was measured.Results:A total of 523 vertebral bodies were measured(excluding 2 female vertebral bodies with poor CT images).The mean left pedicle angle of C3 was 47.37° in males,47.35° in right-side lamina angle,48.20° in right-side vertebral pedicle angle,and 48.21° in left-side lamina angle.The angle difference between pedicle angle and contralateral lamina angle in all C3~C5 males and females was almost less than 1°(R2>0.9,P<0.001),and had a significant correlation(male R2=0.638,female R2=0.572).There was no significant correlation between C6~C7 pedicle angle and contralateral lamina angle(male R2=0.307,female R2=0.226).The minimum pedicle width was 0.29 cm in male and 0.27 cm in female.Conclusion:The axis of the C3~C5 pedicle is approximately parallel to the tangent line of the contralateral lamina,and the contralateral lamina can provide reliable reference for the screw placement angle of the pedicle from the sagittal angle.C6 and C7 are excluded.The safety diameters of pedicle screws were within 0.29 cm in male and 0.27 cm in female.