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1.
青少年胸椎椎弓根影像学特征及其临床意义   总被引:7,自引:0,他引:7  
目的 :探讨青少年胸椎椎弓根影像学特征及其临床意义。方法 :随机选择正常青少年 42人 ,平均年龄12 .4岁 ,摄胸椎X线片 ,对 2 7人行全胸椎椎弓根CT扫描 ,分别测量各节段椎弓根横径、螺钉进钉点和深度 ,以及椎弓根轴线与矢状面夹角等 ,并根据X线测量方法 ,对 10 3例脊柱侧凸患者进行节段椎弓根螺钉器械矫正。结果 :正常C4椎弓根横径最小 (3 .9± 0 .66)mm ,胸椎椎弓根钉进钉点均位于横突根部上缘与中点之间 ,T11、12 椎弓根矢状角为负角 ,其余为正角。 10 3例患者共置入 10 82枚胸椎椎弓根螺钉 ,穿透椎弓根内外侧及椎前皮质的螺钉分别占 18.6%、 14 .5 %和 2 .1% ,仅 1例患者出现了与椎弓根穿透内侧皮质有关的神经系统症状 ,无其他相关并发症。结论 :认真阅读X线片 ,了解与掌握不同节段椎弓根形态特征及周围解剖关系 ,有助于进行正确的胸椎椎弓根螺钉置入。  相似文献   

2.
国人下胸椎及腰椎椎弓根形态学特点及其临床意义   总被引:8,自引:0,他引:8  
为明确国人下胸椎及腰椎椎弓根解剖特点及其定位标志,作者对40具T_9~L_5段尸体脊椎标本的椎弓根进行了形态学研究。测量指标包括椎弓根高、宽、椎弓根后缘皮质到椎体前缘皮质的距离、椎弓根轴线与椎体矢状面夹角及其横断面在椎板的投影与关节突和横突的关系。测量结果提示:在进行椎弓根螺钉固定时,应根据不同节段椎弓根形态学特点,选择相应的表面标志、进针角度及深度。  相似文献   

3.
国人下胸椎及椎椎弓根形态学特点及其临床意义   总被引:38,自引:2,他引:36  
为明确国人下胸椎及腰椎椎弓根解剖特点及其定位标志,作者对40具T9~L5段尸体脊椎标本的椎弓根进行了形态学研究。测量指标包括椎弓根高、宽、椎弓根后缘皮质到椎体前缘皮质的距离、椎弓极轴线与椎体矢状面夹角及其横断面的椎板的投影与关节突和横突的关系。测量结果提示:在进行椎弓根螺钵固定时,应根据不同节段椎形态学特点,选择相应的表面标志、进针角度及深度。  相似文献   

4.
[目的]探讨进钉点到棘突中心矢状面的垂直距离用于椎弓根螺钉个体化植入的可行性.[方法]于华中科技大学同济医学院解剖教研室收集成人脊柱标本30例,在CT横断面扫描图像上测量如下数据:椎弓根宽度a,进钉点到椎体前缘的距离b,进钉点到棘突中心矢状面的垂直距离c,椎弓根纵轴与椎体矢状轴的夹角A,在侧位片上测量椎弓根纵轴与操作台垂直线的夹角B,分为实验组和对照组,实验组采用CT图像上进钉点到棘突中心矢状面的垂直距离用于进钉点在水平方向上的定位,对照组采用Ebraheim法定位进钉点,置钉后行CT扫描,判断螺钉有无穿破椎弓根内侧或外侧壁及穿破程度,按照穿破程度进行分级:A=完全位于椎弓根内;B:穿破程度<2 mm;C=穿破程度2~4 mm;D=穿破程度>4 mm,并进行对比分析.[结果]实验组T3-10水平螺钉穿破率明显低于对照组,T1,T2,T 11,12:两组的穿破率相当.在T 3-18水平,螺钉的穿破程度(C,D级)明显高于其他节段,与椎弓根在这些节段横径变小有关;T 1-12,实验组中C,D级的发生率低于对照组.[结论]采用进钉点到棘突中心矢状面的垂直距离用于定位椎弓根螺钉进钉点,可以明显提高螺钉在水平方向上的植入准确性.尤其在L 3-10节段,而且特别适合由于解剖变异,外伤,肿瘤破坏等原因使关节突关节,横突等解剖标志发生改变时椎弓根螺钉的植入,亦可以在正常解剖情况下作为传统定位方法的有效补充.  相似文献   

5.
胸椎骨折椎弓根螺钉内固定的临床研究   总被引:3,自引:3,他引:0  
目的总结分析胸椎骨折椎弓根螺钉入点和角度。方法对16例胸椎骨折行椎弓根螺钉内固定,术后经CT或MRI复查,总结分析T1~T10共108枚椎弓根螺钉位置。结果34枚螺钉穿出椎弓根或椎体,穿出率31.48%。74枚螺钉未穿出椎弓根及椎体,其中71枚矢状夹角在10°~20°之间,入钉点均在关节突关节外缘。结论胸椎椎弓根狭窄,经椎弓根螺钉容易穿出,选择关节突关节的外缘与横突基底的上缘交点,10°~20°矢状夹角进钉,必要时可运用椎弓根外螺钉置钉是安全牢靠的方法。  相似文献   

6.
【摘要】 目的:测量1~6岁小儿胸椎椎弓根的形态学参数,为小儿胸椎椎弓根螺钉固定提供解剖学依据。方法:收集2009年7月~2010年1月在北京儿童医院行胸部CT检查的1~6岁非脊柱疾患小儿胸椎螺旋CT影像资料。根据年龄将入组儿童分为1~岁组(1组),2~岁组(2组),4~6岁组(3组),每组20例。每例均测量T1~T12左右两侧椎弓根参数共24组数值。将64排螺旋CT平扫胸椎的三维重建数据传至工作站,在多平面重建技术下获得每个椎弓根的矢状面及横断面成像,测量胸椎椎弓根横径(内外径)、纵径(内外径)、骨-螺钉通道长度、椎弓根横断面夹角、椎弓根矢状面夹角,并将上述各参数与年龄进行相关性分析,椎弓根横断面夹角和椎弓根矢状面夹角年龄组间采用多重T检验。结果:(1)椎弓根的横径(内外径)T1~T4逐渐减小,T5~T12逐渐增大;横内径值(除T1、T6、T11、T12外)与年龄无显著相关性(rs:0.011~0.363,除T1、T6、T11、T12外,P>0.05),其随年龄增长变化不明显;横外径值(除T4外)与年龄均存在显著正相关性(rs:0.151~0.539,除T4外,P<0.05),其随年龄增长而增长。(2)椎弓根纵径(内外径)T1~T12逐渐增大,除T1外纵径均大于横径;各节段参数与年龄均存在显著正相关性(纵内径rs:0.526~0.786,纵外径rs:0.692~0.864,P<0.05)。(3)骨-螺钉通道长度各年龄组中最短为T1或T2,最长为T9或T10,T1~T9有逐渐增加的趋势,T10~T12有逐渐减小的趋势;各节段参数与年龄均存在显著正相关性(rs:0.299~0.676,P<0.05)。(4)椎弓根横断面夹角最大为T1,T1~T12逐渐减小,部分小儿T11及T12的椎弓根横断面夹角可达0°甚至负角,除T1外,其余各节段参数与年龄均存在显著负相关性(rs:-0.432~-0.107,除T1 P>0.05外,余P<0.05),1组与2、3组间存在显著性差异(P<0.05),2组与3组间无显著性差异(P>0.05)。(5)椎弓根矢状面夹角T1~T12呈下降趋势,各节段参数与年龄无显著相关性(rs:-0.125~0.127,P>0.05),1、2、3三组间无显著性差异(P>0.05)。结论:1~6岁小儿胸椎椎弓根横外径、纵经、骨-螺钉通道长度与年龄的相关性较大,而椎弓根横内径的生长速度较慢,与年龄的相关性较小;横断面及矢状面夹角与年龄的相关性较小,除1~岁年龄组外,其余年龄段的参数值随年龄增长无明显变化。因此行1~6岁小儿胸椎椎弓根螺钉内固定手术时,应根据患儿年龄及术中情况妥善选择螺钉型号及进钉方式,以避免手术风险。  相似文献   

7.
下胸椎和腰椎椎弓根形态学测量及其临床意义   总被引:7,自引:0,他引:7  
对15具T9-L5段尸体脊椎标本的椎弓根进行了实体及X线片形态学测量。测量内容包括、椎弓根高、椎弓根宽、椎弓根后缘皮质与前缘皮质的距离及椎弓根轴线与矢状面夹角。结果提示:临床应用椎弓根螺钉固定时,应选择合适的螺钉,选准进钉点,并注意进钉方向及深度。  相似文献   

8.
对15具T_9—L_5段尸体脊椎标本的推弓根进行了实体及X线片形态学测量.测量内容包括:椎弓根高、椎弓根宽、椎弓根后缘皮质与前缘皮质的距离及椎弓根轴线与矢状面夹角.结果提示:临床应用椎弓根螺钉固定时,应选择合适的螺钉,选准进钉点,并注意进钉方向及深度.  相似文献   

9.
胸椎椎弓根螺钉固定矫治青少年脊柱侧凸   总被引:17,自引:5,他引:12  
目的 :探讨青少年胸椎椎弓根螺钉的固定方法及注意事项。方法 :测量 2 0例正常青少年胸椎椎弓根影像学参数 ,并在此基础上采用自行设计的胸椎椎弓根螺钉固定器械 (Scofix器械 ) ,对 32例青少年脊柱侧凸进行了矫正治疗。结果 :正常青少年T4椎弓根横径最小 ( 3 9± 0 6 6mm) ,胸椎椎弓根中点均位于横突根部上缘与中点之间 ,椎弓根与矢状面夹角在T11、T12为负角 ,T10以上为正角 ,T1最大 ( 35 8°± 0 84°)。 2 7例患者术后平均随访 11个月 ,特发性和先天性侧凸的矫正率分别为 5 7 8%和 46 4% ,无严重并发症。结论 :根据测量结果 ,如选择好进钉点、方向及深度 ,Scofix器械对青少年脊柱侧凸的矫正可获得更好的稳定性和固定强度  相似文献   

10.
【摘要】 目的:通过放射解剖学研究及标本上的模拟手术操作来验证上胸椎(T1~T4)前路逆向椎弓根螺钉内固定技术的可行性及安全性。方法:在放射科CT数据库中选取40例层厚为0.625mm的正常上胸椎薄层CT扫描数据(男20例,女20例,年龄18~68岁,平均39.7岁),对数据进行MPR重建,在每侧椎弓根轴心上选取其横切面和矢状面进行观察和测量,测得每侧椎弓根的横径、高度、横切面进钉点距离、进钉角度、矢状面进钉点距离、进钉角度、钉道长度,对所得数据进行统计学处理。选取10具(男5例、女5例,年龄不详)完整的成人上胸椎防腐标本(包括C7~T6),外观无畸形和破损,完整保留T1~T4两旁肋椎关节及椎旁软组织,于椎体前方逆向置入椎弓根螺钉,通过X线透视、CT扫描、剖面观察、测量,参照Rao等的椎弓根螺钉穿破分级标准对置钉优良率进行评测。结果:T1~T4椎弓根横径逐渐减小8.14~3.47mm;椎弓根高度逐渐增大6.89~10.29mm;横切面进钉角度逐渐减小32.96°~11.64°;横切面进钉点距离逐渐增大1.80~5.50mm;矢状面进钉角度逐渐增大104.95°~115.74°;矢状面进钉点距离逐渐增大5.95~8.76mm;钉道长度32.95~35.96mm。T3、T4椎弓根横径过于细小,不适合逆向椎弓根螺钉的置入,但在T3、T4逆向置入椎弓根-肋骨复合体螺钉是可行的。T1、T2前路逆向椎弓根螺钉的规格为:直径4.0mm、长度35mm左右,T3、T4前路逆向椎弓根-肋骨复合体螺钉的规格为:直径5.0mm、长度35mm左右。在10具上胸椎标本上共置钉80枚,根据Rao等的椎弓根螺钉穿破分级标准,总体优良率达90%,其中椎弓根侧壁穿破小于2mm未造成脊髓压迫的共7枚;椎弓根内侧壁穿破距离在2~4mm的共有5枚,分别为T1椎体1枚,T3椎体1枚,T4椎体3枚,有不同程度脊髓压迫;椎弓根内侧壁穿破距离大于4mm的2枚,其中T2椎体1枚,T4椎体1枚,脊髓受压严重;T2椎体有1枚椎弓根外侧壁穿破。结论:T1、T2椎体前路逆向椎弓根螺钉内固定技术和T3、T4椎体前路逆向椎弓根-肋骨复合体螺钉内固定技术可达到双皮质固定的目的,但其安全性及临床实用性尚需进一步探讨。  相似文献   

11.
Our objective was to quantify the morphometric characteristics of the pedicles of the Chinese immature thoracic spine. A total of 120 patients aged 5–14 years underwent standard thoracic computed tomography (CT). The patients were grouped according to age: group 1 (5–8 years of age), group 2 (9–11 years of age) and group 3 (12–14 years of age). Images were reformatted, and multiplanar reconstructions were used to attain images of thoracic pedicles on sagittal, coronal and transverse planes. The measurements included the inner and outer pedicle diameters on the transverse plane, pedicle sagittal diameter, pedicle length and the pedicle angle on the transverse. (1) Pedicle diameters on the transverse plane decreased gradually from T1 to T4 and increased gradually from T5 to T12. The shortest transverse diameter of the thoracic pedicle was T4 or T5. (2) The sagittal diameter was significantly larger than the transverse diameter except at T1. (3) The length of the pedicle from the posterior cortex to the anterior cortex of the vertebra increased from T1 to T12. (4) The pedicle angle decreased gradually from T1 to T8 and became negative below the level of T10. The length of the pedicle changed with age significantly, but the pedicle angle changed with age insignificantly. The success of transpedicular fixation requires a better understanding of morphological features at different ages and reasonable selection of the diameter, length and direction of the pedicle screws based on X-ray and CT films.  相似文献   

12.
A total of 2,905 pedicle measurements were made from T1-L5. Measurements were made from spinal computerized tomography (CT) scan examinations and individual vertebral specimen roentgenograms. Parameters considered were the pedicle isthmus width in the transverse and sagittal planes, pedicle angles in the transverse and sagittal planes, and the depth to the anterior cortex in a line parallel to the midline of the vertebral body and along the pedicle axis. There was no significant difference between data obtained from CT scans and specimen roentgenograms. Pedicles were widest at L5 and narrowest at T5 in the transverse plane. The widest pedicles in the sagittal plane were seen at T11, the narrowest at T1. Due to the oval shape of the pedicle, the sagittal plane width was generally larger than the transverse plane width. The largest pedicle angle in the transverse plane was at L5. The posterolateral to anterolateral pedicle axis orientation in the transverse plane, seen at other levels throughout the thoracolumbar spine, reversed at T12. In the sagittal plane, the pedicles angled caudally at L5 and cephaladly from L3-T1. The depth to the anterior cortex was significantly longer along the pedicle axis than along a line parallel to the midline of the vertebral body at all levels with the exception of T12 and T11.  相似文献   

13.
椎板后壁部分刮除辅助透视行颈椎弓根钻孔   总被引:3,自引:1,他引:2       下载免费PDF全文
目的探索椎板后壁部分刮除辅助透视行下颈椎椎弓根钻孔的可行性。方法3具新鲜尸体下颈椎的30例椎弓根,透视确定椎弓根轴线所在高度,将此高度侧块与椎板后壁交界内外侧各5mm范围内的皮质骨去除,刮除其下松质骨,先暴露出内侧的椎板前壁,后紧贴椎板前壁向外侧刮除,找到椎弓根入口。根据内倾角确定入口外侧骨质去除范围,以椎弓根内壁为参照,透视确定上倾角,行髓腔钻孔。CT扫描明确钻孔准确性。结果1例髓腔消失,放弃钻孔;27例钻孔准确;2例髓腔〈3mm,椎弓根外壁向外侧移位,但〈2mm。结论椎板后壁部分刮除辅助透视行下颈椎椎弓根髓腔钻孔效果满意。  相似文献   

14.
The pedicles of lumbar vertebrae were measured both directly and radiographically to determine the differences between the sexes and the accuracy of radiographic measurement. The lumbar pedicles of cadavera of forty-nine patients--twenty-four men and twenty-five women--who died between the ages of sixty and ninety-eight years were measured directly and on radiographs. The pedicles of lumbar vertebrae from fifty-one patients--twenty-three men and twenty-eight women--between the ages of twenty and fifty years who had low-back problems were measured on radiographs and computerized tomographic scans. Comparison revealed that the average transverse and sagittal diameters of the pedicles and the distance from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body along the central axis of the pedicles were 5 to 20 per cent greater in men, but the transverse and sagittal angles of the pedicle did not differ significantly between the sexes. Measurements on radiographs and computerized tomographic scans of the transverse angles of the pedicles and of the distances from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body from the second to the fifth lumbar vertebra were greater than direct measurements, even without magnification. Direct measurements of the diameters of the transverse and sagittal diameters of the pedicle of the fifth lumbar vertebra, however, were greater than the radiographic measurements.  相似文献   

15.
Although several studies have been reported on the adult vertebral pedicle morphology, little is known about immature thoracic pedicles in patients with idiopathic scoliosis. A total of 310 pedicles (155 vertebrae) from T1 to T12 in 10–14 years age group were analyzed with the use of magnetic resonance imaging and digital measurement program in 13 patients with right-sided thoracic idiopathic scoliosis. Each pedicle was measured in the axial and sagittal planes including transverse and sagittal pedicle width and angles, chord length, interpedicular distance and epidural space width on convex and concave sides of the curve. The smallest transverse pedicle widths were in the periapical region and the largest were in the caudal region. No statistically significant difference in transverse pedicle widths was detected between the convex and concave sides. The transverse pedicle angle measured 15.56° at T1 and decreased to 6.32° at T12. Chord length increased gradually from the cephalad part of the thoracic spine to the caudad part as the shortest length was seen at T1 convex level with a mean of 30.45 mm and the largest length was seen at T12 concave level with a mean of 41.73 mm. The width of epidural space on the concave side was significantly smaller than that on the convex side in most levels of the curve. Based on the anatomic measurements, it may be reasonable to consider thoracic pedicle screws in preadolescent idiopathic scoliosis.  相似文献   

16.
Posterior instrumentation through the pedicle is a common surgery. Understanding the morphometry of the pedicle and the anatomy of adjacent neural structures should help decrease the risk of postoperative complications. T1–L5 segments from 15 sets of human vertebrae were separated into individual vertebrae and the morphometric characteristics of the thoracic and lumbar spine and the safe zone of the pedicle were analyzed. T11–L5 segments from six human cadavers were dissected. Measurements were taken from the pedicle to the dura and nerve roots superiorly, inferiorly, medially, and laterally, and the transverse angles of the nerve roots were measured. Pedicles were widest in L5 and narrowest in T4 in the transverse plane, and widest in T11 or T12 and narrowest in T1 in the sagittal plane. In individual pedicle, the ranges of the safe zone width and height were 3.4–7.7 and 8.6–13.7 mm, respectively, in T1–T10; and 7.2–17.8 and 13.9–16.7 mm, respectively, in T11–L5. The transverse angle of the pedicle decreases progressively from T1 to T12, then increase from L1 to L5. In sagittal angle, the largest angle localized at T2 and the smallest at L5. The mean distances from pedicles to adjacent neural structures were greater superiorly and laterally than inferiorly and medially. The lateral distance between nerve root and the pedicle ranged from 2.4 to 9.6 mm in lumbar spine. This study provides potential safe zones for the application of through-pedicle procedures to help decrease the risk of postoperative complications.  相似文献   

17.
 目的明确胸椎后路经关节突关节椎弓根螺钉固定的解剖学可行性和技术参数.为临床应用提供参考。方法取 20具胸椎标本.仔细解剖胸椎的后侧和前侧方.以清楚地暴露胸椎椎板和椎弓根。以椎板下缘向上、外缘向内各 7 mm为进钉点.在 T1.2、T5.6、T9.10直视下置入经关节突关节椎弓根螺钉.通过直接的置钉和 CT重建.观察胸椎后路经关节突关节椎弓根螺钉实际置钉的可行性.测量经关节突关节椎弓根螺钉内固定进钉角度和钉道长度。结果所有胸椎后路经关节突关节椎弓根螺钉均由上位胸椎下关节突经关节突关节.进入下位胸椎的椎弓根.成功置入下位胸椎的椎体内。重建 CT测量发现螺钉在横断面的外倾角度为 2.1°±0.7°.在矢状面的尾倾角度为 41.4°±3.2°.在各节段间略有不同.但差异无统计学意义。平均的螺钉钉道长度为(40.6±4.9) mm.钉道长度由上胸椎向中、下胸椎呈逐渐增加趋势.差异有统计学意义(F=74.09, P<0.01)。结论胸椎后路经关节突关节椎弓根螺钉具有解剖学可行性.可以作为胸椎椎弓根螺钉固定的一种补充内固定方法.但置钉时要求较高的准确性。  相似文献   

18.
Objective: To explore the influence of pedicle screw insertion through the neurocentral cartilage (NCC) on the development of vertebrae and spinal canal in an animal experiment. Methods: Sixteen dogs were randomly assigned to three groups: in group 1, posterior muscles at the surgery site were dissected; in group 2, the pedicles were drilled through the NCC by screws; in group 3, screws were placed in the pedicles through the NCC. Vertebrae of T8, T10, T12, L2, L4 and L6 were studied with the average data of the adjacent two vertebrae serving as controls. Spiral computerized tomography (CT) was used to assess the morphologic parameters of studied vertebrae and their controls. Measurements were made by an independent radiologist on the first post‐operative day and 3 months after operation. Paired Student's t‐tests of studied vertebrae and their controls were performed to evaluate the effect of pedicle screw insertion. Results: In group 3, 3 months after operation the area, transverse diameter and anterior‐posterior diameter of the vertebral canal and length of pedicle of studied vertebrae were significantly smaller than those of control vertebrae (P < 0.05). There were no significant differences in morphologic parameters between the studied vertebrae and the control vertebrae in groups 1 and 2 (P > 0.05). Conclusion: (i) Pedicle screw placement has a significant impact on the growth of the canine vertebra canal, and may lead to iatrogenic spinal stenosis, but their placement has no significant effect on the vertebral bodies; and (ii) the NCC can repair itself automatically. Drilling pedicle bone through the NCC with a screw and then removing the screw has no obvious impact on the growth of vertebrae.  相似文献   

19.
目的:探讨胸腰椎椎弓根的径线和偏角与脊椎节段序数的相关性.方法:46具国人成年男性脊柱标本,拍胸椎及腰椎侧位X线片,并进行CT扫描.测量每个椎体椎弓根钉道长度、椎弓根内径宽度、椎弓根间距、椎弓根与矢状面夹角(e角)和椎弓根与横断面夹角(f角).将T1~L5脊椎节段序数按照1~17进行编号.应用SPSS 11.5软件进行统计分析.结果:T1-L4椎弓根钉道长度与脊椎节段序数呈正的直线相关(R2=0.716);T2~T3椎弓根宽度与脊椎节段序数呈负的直线相关(R2=0.792);T8~L5椎弓根宽度与脊椎节段序数呈正直线相关(R2=0.673).T1~T4椎弓根间距与脊椎节段序数呈负直线相关(R2=0.866);T4-L5椎弓根间距与脊椎节段序数呈正的直线相关(R2=0.771).T1~T2椎弓根f角与脊椎节段序数呈正直线相关(R2=0.767);T2~T4椎弓根f角与脊椎节段序数呈正直线相关(R2=0.908);T7~L5椎弓根f角与脊椎节段序数呈负的直线相关(R2=0.931);T1~T6椎弓根e角与脊椎节段序数呈负的直线相关(R2=0.774),T12~L5椎弓根e角与脊椎节段序数呈正的直线相关(R2=0.710).而T1~T2及T4~T7椎弓根宽度、T4~T6椎弓根f角以及T6-T12椎弓根e角与脊椎节段序数之间无显著相关性.结论:除T1~T2和T4~T7椎弓根宽度、T4~T6椎弓根f角以及T6~T12椎弓根e角外,国人成年男性胸腰椎椎弓根径线和偏角与脊椎节段序数之间有线性相关性,其回归方程有显著性意义.  相似文献   

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