颈胸段椎弓根钉矢状面徒手进钉角度与邻近解剖标志研究

目的:测量多个解剖标志与上终板平面之间的角度,寻找颈胸段(C6~T6)脊柱后路手术术中椎弓根螺钉矢状面徒手进钉角度(sagittal screw angle,SSA)新的定位技术?方法:选择60例(男女各30例)正常成人颈胸段(C6~T6)CT片,分别测出上终板平面在矢状面上与同一椎骨棘突与相邻上棘突顶点连线夹角(方法1);相邻下棘突顶点连线夹角(方法2);同一椎骨棘突嵴线夹角(方法3);同一椎骨左侧椎板平面的夹角(方法4);右侧椎板平面的夹角(方法5)?得出每个椎骨各种方法的参考值,比较各方法的优劣,采用其中一种或者几种方法作为颈胸段(C6~T6)脊柱后路手术椎弓根螺钉矢状面徒手进钉角度定位新技术?结果:上终板平面和同一椎骨棘突与相邻上下棘突顶点连线夹角在下颈椎C6到C7段角度在100°~110°之间且数值差异较大,在上胸椎T1到T6两种方法的角度值趋于90°,差异相对较小;上终板平面和同一椎骨棘突嵴线夹角从C6到T6角度值逐渐变小;上终板平面和同一椎骨左右侧椎板平面夹角基本为90°即垂直位?结论:在颈胸段(C6~T6),当椎弓根螺钉垂直于椎板平面进钉时,即椎弓根螺钉在矢状面上角度为0°,椎板平面可作为颈胸段(C6~T6)椎弓根螺钉矢状面徒手进钉角度的解剖标志?

A study on angles of free hand pedicle screw placement and adjacent anatomic landmarkers in the sagittal plane of pedicle of cervicothoracic segments

Objective:To find a new technique for determine sagittal screw angle(SSA)cervicothoracic spine (C6-T6) pedicle screw placement by measuring the angles between different anatomic landmarks and between planes of upper vertebral end-plate. Methods:CT images of 60 cases (thirty males and thirty females) of normal adult human cervicothoracic segments (C6-T6) were analyzed in thiss study,The angles between the plane of the upper vertebral end-plate and the line between the vertex of the spinous process and the upper one (method one); the lower one (method two); the superior margin line of spinous process (method three); the left vertebral laminae plane of the same spine (method four); the right vertebral laminae plane of the measuring same spine (method five)were measured ,respectively. One or several methods was be chosen as a new placement technique for cervicothoracic spine(C6-T6)pedicle screw surgery on SSA by the reference values of each method in C6-T6 and comparing the pros and cons of different methods. Results:The angles between the plane of the upper vertebral end-plate and the line between vertex of spinous proscess and adjacent ones were 100° to 110°with great deviation in C6 to C7,and from T1 to T6,the angles approached 90°with smaller deviation;the angles between the plane of the upper vertebral end-plate and the left vertebral laminae plane decreased gradually from C6 to T6. The vertebral laminae plane was 90° in the vertical position. Conclusion:If the angles of pedicle screw agianst the vertebral laminae plane are about 90° at C6 to T6,the sagittal srew surgery are 0°,the vertebral laminae plane can be the identification marker for cervicothoracic spine(C6-T6) pedicle screw surgery on SSA.