腰椎皮质骨螺钉在X线片上进针点及进针轨迹的临床研究

Clinical study of needlepoint and needle track on X-ray film of the lumbar cortical bone screw

研究腰椎皮质骨螺钉植入时,进针点及进针深度在腰椎标准正侧位的投影点位置及在时钟点位置,为临床正确置钉提供理论依据。采用10具L1-L5脊柱标本,解剖出单个椎体,将导针完全植入皮质骨通道内,确定完整钉道,椎弓根内侧壁没有破坏,然后测量分析下列数据:(1)进针点的时钟法记录位置;(2)在椎弓根中段时,导针尖部的投影位置;(3)在椎体与椎弓根交界处,导针尖部的投影位置;(4)在上终板下方位置处,导针尖部的时钟法记录位置。结果显示:(1)进针点在椎弓根位置左侧位于5点钟方向,右侧位于7点钟方向,出针点在左侧指向11点钟位置,右侧指向1点钟方向;(2)在椎弓根中段,导针尖部在椎弓根投影的中下方靠近椎弓根内侧壁的位置;(3)在椎体与椎弓根交界处,导针位置位于椎弓根投影的上极。

To study the position of the projection point and the depth of the needle insertion point and depth on the standard or lateral lumbar spine when the lumbar cortical bone screw is implanted, and to provide a theoretical basis for correct nail placement. Ten L1-L5 spine specimens were used to dissect a single vertebral body. The insertion point of the cortical bone channel screw was the intersection of the vertical midline of the corresponding articular process on the corresponding vertebrae and the horizontal line of 1 cm below the ipsilateral transverse process. The open cone was open, the valgus angle was controlled at 10°, and the head tilt angle was 25°-30°. The guide needle was completely implanted into the cortical bone channel to determine the complete nail channel, and the inner sidewall of the pedicle was not damaged. Then the following data were measured and analyzed:(1) The clock recording position of the needle insertion point;(2) In the middle of the pedicle, the position of the needle tip: the projection point on the clock and the distance from the medial edge of the pedicle;(3) At the junction of the pedicle, the position of the tip of the guide pin, the distance from the medial edge of the pedicle;(4) At the position below the upper-end plate, the position of the clock of the guide pin records the position. The results showed:(1) The needle entry point was at 5 o’clock on the left side of the pedicle, and the right side was at 7 o’clock. The needle exit point was on the left side at 11 o?clock, and the right side was at 1 o?clock. In the middle part of the pedicle, the tip of the guide needle was close to the inner side of the pedicle in the middle and lower part of the pedicle projection.(3) At the junction of the vertebra and the pedicle, the guide needle was located at the upper pole of the pedicle.