新型自导向椎弓根丝锥可行性的解剖学研究

Anatomical study on the feasibility of a new self-guided pedicle tap

目的:探讨应用新型自导向椎弓根丝锥辅助椎弓根螺钉置入的准确性和安全性。方法:根据椎弓根的解剖特点,研制新型自导向椎弓根丝锥。选择成人脊柱标本6具,其中男性4具,女性2具,分别采用传统丝锥(对照组)和新型自导向丝锥(实验组)对T1-L5同节段的每一对椎弓根的左侧和右侧进行攻丝,并置入椎弓根螺钉。使用秒表记录并比较两组的置钉时间。通过脊柱标本的CT扫描,将其影像学结果按照Heary分级观察螺钉置入的准确性和安全性。结果:实验组胸腰椎置钉时间分别为(5.87±1.25)min,(5.45±1.67)min,对照组胸腰椎置钉时间分别为(6.12±1.69)min,(6.22±2.13)min,两组比较差异无统计学意义(P>0.05)。两组椎弓根螺钉的Heary分级显示,实验组HearyⅠ级和HearyⅠ+Ⅱ级分别为86枚(84.31%)和96枚(94.12%),对照组HearyⅠ级和HearyⅠ+Ⅱ级分别为72枚(71.29%)和84枚(83.17%),两组比较差异有统计学意义(P<0.05)。结论:新型自导向椎弓根丝锥能够准确和安全地置入胸腰椎弓根螺钉,且成本低廉、操作简便,具有良好的临床应用价值。

Objective:To evaluate the accuracy and safety of pedicle screw placement using a new self-guided pedicle tap.Methods:According to the anatomical characteristics of the pedicle,a new self-guided pedicle tap was developed.Six adult spinal specimens including 4 males and 2 females were selected and tapped thread on the right and left sides of each pair of pedicles from the same segment T1 to L5 with traditional taps(control group)and new self-guided pedicle taps(experimental group),respectively.And the pedicle screws were placed.The screwing time was recorded and compared between two groups.CT scanning was completed to observe the accuracy and safety of the screw placement according to the Heary classification of imaging results.Results:The screwing time of thoracic and lumbar vertebrae in the experimental group were(5.87±1.25)min and(5.45±1.67)min,respectively.While those in the control group were(6.12±1.69)min and(6.22±2.13)min,respectively.Then there was no significant difference in screwing time of thoracic and lumbar vertebrae between two groups(P>0.05).The Heary grade of the pedicle screw showed that Heary gradeⅠand Heary gradeⅠ+Ⅱwere respectively 86(84.31%)and 96(94.12%)in the experimental group,72(71.29%)and 84(83.17%)in control group,and the difference between two groups was statistically significant(P<0.05).Conclusion:The new self-guided pedicle tap can accurately and safely insert the thoracolumbar pedicle screw,with low cost,easy operation,and good clinical application value.