L_(5)~S_(1)椎前路经椎弓根安全置钉的解剖学研究

The anatoink study of anterior pedicle screw placement for L5〜S1

目的对正常成人L_(5)~S_(1),脊椎标本进行解剖学测量,评价L_(5)~S_(1)前路经椎弓根固定的可行性。方法取30套正常成人L_(5)~S_(1)脊椎骨架标本,测量椎体高度、宽度、前后径,椎弓根高度、宽度,前路椎弓根螺钉进钉点距椎体上下终板、椎体中线的距离,椎骨螺钉通道长度(BSPL)。取30具其软组织结构完整的腰骶段成人尸体标本,测量腹主动脉分又与髂总静脉汇合点至Ls椎体下缘的距离,髂总静脉汇合点至Ls椎体下缘的距离,髂总静脉内缘在L_(5)~S_(1)椎间盘水平的距离,第一骶孔间距离,计算腰骶前路手术“安全工作区”区城面积。结果Ls椎体宽(47.5±3.2)mm,椎体前后径(33.6±1.7)mm,高(27.5±4.2)mm;椎弓根高(14.6±1.1)mm,椎弓根宽(14.0+1.2)mm;椎骨螺钉通道长(48.2+4.4)mm。L;前路进钉点距上终板为(12.4±1.3)mm,距下终板为(17.5±1.5)mm,距中线距离为(6.4±0.7)mm。S.椎体宽(29.5±3.8)mm,前后径(32.5±19)mm,高(31.2±3.2)mm;椎弓根高(17.5±1.4)mm,椎弓根宽(11.4±1.4)mm;椎骨螺钉通道长(45.4±4.3)mm。S前路进钉点距下终板(26.6±1.3)mm,距中线(6.6±0.7)mm。腹主动脉分叉至Ls椎体下缘的距离为(40.5±9.4)mm,髂总静脉汇合点至Ls椎体下缘的距离为(27.8±8.6)mm,髂总静脉内缘在Ls椎体下缘水平的距离为(37.5+1.3)mm,第一骶孔间距离为29.3±1.3mm,安全工作区面积为(2058.2±84.3)mm^(2)。结论通过分析L_(5)~S_(1)前路椎弓根螺钉置钉的相关解剖学参数,同时证明L_(5)~S_(1)前路椎弓根螺钉置钉是安全可行的。

Objective To perform the anatomical measurements on L5/S1 spine specimens of normal adults,to evaluate the fesility of anterior transpedicular screw technology of the L5/S1.Methods Thirty Ls/Si spine specimens of normal adults were included,and anatomical measurements were performed,including height,width and anteroposterior diameter of vertebral body,height and width of pedicle,the distances between the anterior transpedicular screw insertion point and the upper endplate,lower endplate,and the midline of the vertebral body,and bone screw passageway length(BSPL).Thirty adult cadaver lumbosacral specimens with complete soft tssue structure were included,and anatomical measurements were performed,including the the distance from the cross point of aortic bifurcation and conmon iliac vein to the lower edge of the Ls,the distance from the cross point of common iliac to the lower edge of the Ls,the horizontal distance between the inner edges of the left and right common iliac veins on the L5/S1 intervertebral disc level,the distance between the first sacral foramimas.The“safe working area”for anterior lumbosacral surgery was also measured and calculated.Results In Ls,the width was 47.5±3.2mm,the anteroposterior diameter was 33.6±1.7mm,the height of vertebra was 27.5±42mm,the height of pedicle was 14.6±1.1mm,the width was 140±1.2mm.the disance between the insertion point and the upper endplates was 12.4±1.3mm,the distance between the insertion point and the lower endplates was 17.5±1.5mm,the distance berween the insertion point and midline was 6.4±0.7mm,the BSPL was 48.2±4.4mm.In S,the width was 29.5 t 3.8mm,the anteroposterior diameter was 32.5±19mm,the height of vertebra was 31.2±3.2mm,the height of pedicle was 17.5±1.4mm,the width was 11.4±1.4mm,the BSPL was 45.4±4.3mm.The distance between the insertion point and the lower endplates was 26.6±1.3mm,the distance between the insertion point and midline was 6.6±0.7mm.The distance from the cross point of aoric bifurcation and common iliac vein to the lower edge of the Ls was 40.5±9.4mm,the distance from the cross point of common iliac to the lower edge of the Ls was 27.8±8.6mm,the horizontal distance between the inner edges of the left and right common iliac veins on the Ls/Si intervertebral disc level was 37.5±1.3mm,the distance between the first sacral foraminas was 29.3±1.3mm.The"safe working area"for anterior lumbosacral surgery was 2058.2±84.3mm^(2).Conclusion This study provides anatomical parameters of Ls/Si anterior transpedicular screw technology,and the Ls/S:anterior tanspedicular screw technology is safe and feasible.