下颈椎经椎弓根螺钉置入的应用解剖学研究

Applied anatomy of the lower cervical pedicle screw placement

目的:对椎弓根在相应椎体上的进钉角度以及进钉点的部位进行研究,同时对椎弓根的结构和与之相邻的神经、脊髓之间存在的关系进行分析探究。方法:选取32个成年人,以其C3~7段颈椎作为标本,采用量角器及游标卡尺测量相应角度及长度,并且对标本的相应进钉指标进行对比。结果:在术者对颈椎的标本进行不同程度的定位之后,以椎弓根标本中下平面上1/2椎弓根高处作为横坐标,纵坐标C3为侧块外缘内(2.4±0.9)mm,C5为侧块外缘内(2.8±0.7)mm,C6为侧块外缘内(3.7±0.7)mm,C7为侧块外缘内(5.5±1.3)mm,各个侧块外缘距离没有明显差异,统计学无意义(P>0.05)。结论:在临床上,患者下颈椎的各个部位中,横突后结节与关节突的切迹最高点以及侧块外缘解剖在解剖学上的标志位置最为显著,临床意义十分重大,在手术过程中较容易被发现,因此能够提高手术过程中的安全性,值得推广应用。

Objective:To research on the corresponding vertebral pedicle screw insertion angle and the anchor point of the site,analyzing the relationship between the structure of inquiry pedicle and adjacent nerve,spinal cord.Methods:32 people were selected,with their C3~7cervical as specimens,using a protractor and vernier caliper measuring angles and lengths,and into nail indicators of the specimens were compared.Results:After operation of cervical specimens were positioned in different degree,pedicle specimens on the lower half of the pedicle height as the horizontal plane,ordinate C3 to the outer edge of the inner side of the block(2.4±0.9)mm,C5 is the inside of the outer edge(2.8±0.7)mm,C6 is the inside of the outer edge(3.7±0.7)mm,C7 is the inside of the outer edge(5.5±1.3)mm,there is no significant difference of each side block edge distance,there is no statistically significant(P>0.05).Conclusion:Clinically,all parts of the lower cervical spine in the patient,tubercle of transverse process and the highest point of the notch facet and the outer side block dissection in anatomical position is the most significant symbol,there is a great clinical significance,in the surgical process is more likely to be found,it is possible to improve the safety of the surgical procedure,it is worth promoting.