经椎弓根内固定器治疗腰椎没脱

目的：探讨应用经椎弓根内固定器械治疗腰椎滑税的临床效果。方法：回顾性分析62例腰椎滑脱患,均行椎弓根钉内固定手术治疗。其中Steffee钢板法29例,RF固定法21例及CCD加Cage融合术12例。结果：平均随访2．6年（6个月－5年）,疗疚按Steffee分级：优36例（占58％）,良21例（占34％）,中5例（占8％）。结论：椎弓根钉固定系统是治疗腰椎滑脱的有效方法,其中CCD加Cae椎间植骨融合是治疗腰椎滑脱的一种全新方法,效果优良。     

藏族与汉族成人腰椎椎弓根CT测量比较

[目的]测量西藏藏族成年人腰椎椎弓根形态特点,同时对比藏汉两族及男女之间腰椎椎弓根形态差异,为西藏患者腰椎椎弓根螺钉固定提供可靠的解剖学数据。[方法]随机抽取本院符合纳入标准的测量对象,其中藏族100例,男50例,女50例;汉族100例,男50例,女50例。通过CT检查测量L₁～L₅椎体的椎弓根宽度、轴线长度、矢状径、横断面角和矢状面角,按民族、性别分组比较。[结果]200例受测量者腰椎椎弓根宽度及横断面角度均由L₁到L₅逐渐增大(P<0.05),椎弓根矢状径由L₁至L₅均逐渐减小(P<0.05),腰椎椎弓根的轴线长以L₃最大(P<0.05),腰椎椎弓根矢状面角总体呈下降趋势(P<0.05)。藏族与汉族间腰椎椎弓根各径线的数据部分有差异,同种族间男性腰椎椎弓根宽度、轴线长、矢状径均显著大于女性(P<0.05)。[结论]不同种族、不同性别间腰椎椎弓根形态测量存在差异,因此在行腰椎椎弓根内固定术时置钉角度与螺...     

术前CT测量对胸腰椎椎弓根置钉准确性的影响

椎弓根内固定技术及CT重建技术在脊柱外科的应用越来越广泛.2005年3月～2007年6月我科对进行胸腰椎椎弓根内固定术的63例患者术前行CT检查测量椎弓根的相关参数,术中进行个性化置钉,取得了良好的效果.同时随机选取2000年1月～2005年2月由同一医生组完成但术前未进行CT测量的72例胸腰椎椎弓根内固定患者作为对照组,比较两组患者螺钉置人的准确率.     

术中解剖定位胸腰段椎体及其椎弓根进钉点

采用术中解剖定位法确认置入器械的椎体节段及其椎弓根进钉点，并通过术后摄片判断解剖定位的椎体节段及其椎弓根进钉点的准确性。本组31例，共置钉124枚，位置优102枚，良14枚，优良率93.6％，无一例错置。术中解剖辨认椎体节段及其椎弓进钉点方法简便易行，定位准确。     

椎弓根螺钉治疗胸腰椎爆裂型骨折

胸腰椎爆裂骨折往往伴有脊髓伸经损伤,目前公认的治疗方法是早期复位内固定,恢复脊柱的正常排列及椎管容积,使受损脊髓神经获得减压。2001年3月～2003年3月,笔者对37例胸腰椎爆裂型骨折患者采用椎弓根螺钉复位内固定,取得较好疗效。     

100例国人腰椎弓根的CT测量及其临床意义

对１００例国人腰椎弓根进行了ＣＴ形态学测量。结果表明腰椎弓根厚度从Ｌ１～Ｌ５呈递增趋势，Ｌ１～Ｌ５椎弓很平均厚度分别是５．３、 ６．７、９．５、１１．５和１４．７ｍｍ。椎弓根轴线与椎体棘突中央矢状面夹角（倾斜角），从Ｌ１～Ｌ５亦呈递增趋势，Ｌ１～Ｌ５各椎弓根平均倾斜角分别为１５．９７、１５．９１、１９．１９、２２．７８和２８．４７度。本文亦对椎弓根厚度与椎弓根螺钉的直径及进钉倾斜角进行了探讨，并提出在Ｌ４～Ｌ５节段应使用直径７．０ｍｍ的椎弓根螺钉。     

椎弓根内固定治疗胸腰椎不稳定骨折

20 0 0年 9月～ 2 0 0 1年 12月 ,我们采用椎弓根短节段脊柱内固定器治疗胸腰椎不稳定骨折 ,现将有随诊资料的 4 2例治疗情况分析报道如下。1　材料与方法1.1　病例资料　本组 4 2例 ,男 2 9例 ,女 13例 ,年龄 18～ 5 5岁。手术距受伤时间 1～ 7d ,平均 3 8d。骨折按McAfee等分型〔1〕:不稳定爆裂型骨折27例 ,Chance骨折 6例 ,屈曲牵拉型损伤 4例 ,平移损伤 5例。损伤部位 :T115例 ,T12 17例 ,L116例 ,L2 4例。损伤原因 :砸伤 3例 ,摔伤 4例 ,高空坠落伤 13例 ,车祸伤 2 2例。入院时脊髓神经功能采用Frankel分类法评定 ,A级 6例 ,B级 6…     

后路椎弓根螺钉治疗腰椎爆裂骨折

目的探讨后路椎弓根螺钉治疗腰椎爆裂骨折的临床价值。方法采用后路椎弓根螺钉内固定治疗36例腰椎爆裂骨折患者(38个椎体),通过X线片测量术前、术后1周和术后8个月时椎体前缘相对高度、Cobb角情况。结果患者均获随访,时间8～15个月。伤椎前缘相对高度:术前为42.2%±7.3%,术后1周为98.3%±1.5%,术后8个月为97.5%±1.6%,术后1周及术后8个月较术前明显改善,差异有统计学意义(P<0.05);术后8个月与术后1周比较差异无统计学意义(P>0.05)。Cobb角:术前为19.2°±6.1°,术后1周为2.6°±1.3°,术后8个月为3.3°±1.4°,术后1周及术后8个月与术前比较差异有统计学意义(P<0.05);术后8个月与术后1周比较差异无统计学意义(P>0.05)。患者均未发生内固定失效情况及后凸畸形再发等并发症。结论后路椎弓根螺钉是治疗腰椎爆裂骨折较理想的方法。     

椎弓根螺钉内固定治疗腰椎滑脱

１　临床资料１１　一般资料　本组８５例,男５４例,女３１例,年龄３５～６０岁。症状及体征　本组均有顽固性腰痛,间歇性跛行２０例,一侧下肢放射痛５０例,伴一侧大腿酸痛２５例,两侧小腿酸痛１４例。体征：腰椎前凸臀部后凸增加,腰骶部压痛２０例,棘突呈台阶状６８例,直腿抬高试验阳性２３例,膝反射减弱１０例,跟腱反射减弱２５例。Ｘ线片示：腰４双侧椎弓峡部崩裂伴滑脱４５例,腰５双侧弓峡部崩裂伴滑脱３９例,腰５退行性滑脱１例,术前椎体滑脱率最轻为５％,最重为５５％,平均为３０５％。治疗　本组采用Ｓｔｅｆｆ…     

三维CT模拟双通道螺钉置入同一腰椎椎弓根成功率的影响因素分析

目的 通过三维CT模拟椎弓根螺钉(pedicle scrw,PS)和皮质骨通道螺钉(cortical bone tra?jectory,CBT)置入同一腰椎椎弓根,并分析置钉成功率的影响因素.方法 应用Mimics 10.0软件重建49例病人腰椎三维图像,测量双侧L1～L5椎弓根直径(横径和纵径).将横径及纵径各分为3...     

下颈椎椎弓根螺钉内固定相关参数的解剖学和影像学测量

目的:测量成人下颈椎椎弓根相关径线,为临床应用下颈椎椎弓根螺钉内固定提供相关解剖参数.方法:成人干燥尸体颈椎C3～C7标本20具,分别用手工和CT测量椎弓根宽度、高度,从横断面CT图像上测量椎弓根的内部宽度、内部高度,从纵断面CT图像上测量椎弓根矢状角.随机在CT窒保存的100例成人患者的颈椎CT图像上测量椎弓根的宽度、自身长度和椎弓根通道全长、椎弓根内倾角.结果:下颈椎标本各节段椎弓根宽度、高度的手工测量值与CT测量值比较无统计学差异(P>0.05),椎弓根宽度小于高度;C3～C6节段CT测量椎弓根内部宽度平均为2.5～2.8mm,椎弓根内部高度平均为2.9～3.0mm,C7椎弓根的内部宽度和高度接近,约4.0mm;下颈椎标本CT测量椎弓根矢状角分别为C3 8.6°,C4 4.6°,C5-1.3.,C6-4.0°,C7-8.2°.100例成人下颈椎CT图像测量椎弓根宽度最小值为3.1mm(C3),最大值为9.3mm(C7),其中>3.5mm者为92.8%;椎弓根自身长度平均为19.1～20.5mm,椎弓根通道全长平均为33.2～35.0mm,椎弓根内倾角平均值C3～C5为43.2°～45.1°,C6为40.8°,C7为37.5°.结论:术前CT测量可为椎弓根准确置钉提供可靠的解剖参数,下颈椎椎弓根一般可接受直径3.5mm的螺钉同定.     

带L3动脉蒂脂肪片的解剖及其在腰椎间盘突出症二次手术中的应用

目的：观察带k动脉蒂肌筋膜脂肪片的血供解剖及其对腰椎间盘突出症二次手术疗效的影响。方法：观测6例12侧成人尸体标本腰节段血管的走行及L3动脉在腰背肌筋膜血供分布。2000年1月至2007年1月共收治腰椎间盘突出症二次手术患者49例,男26例,女23例;年龄39-70岁,平均55．6岁;两次手术间隔为8个月～15年,平均6．9年。复发腰椎间盘突出症30例,硬膜外瘢痕形成17例,硬膜外囊肿2例。9例行后路腰椎椎间融合术。所有患者以L3动脉为蒂的脂肪片覆盖于椎板开窗处,术后负压引流管拔出后,将2ml几丁糖从硬膜外导管注入椎板开窗处硬膜及神经根周围。随访期间进行视觉模拟评分（VAS）与Oswestry功能障碍指数评分,并与术前进行比较。结果：解剖发现L3节段血管走行较为恒定,其穿出胸腰筋膜后形成丰富的真皮下毛细血管网。49侧患者随访5～8年,平均为5．6年。腰痛VAS评分由术前7．6±1．2降至末次随访3．6±0．5（t=5．56,P〈0．01）,腿痛VAS评分由术前8．9±0．9降至末次随访3．0±0．4（t=8．61,P〈0．01）;ODI评分从术前44．1±6．2降至末次随访13．9±3．6（t=20．32,P〈0．01）。根据ODI评分评定结果：优29例,良11例,可7例,差2例。结论：带蒂脂肪片加几丁糖能有效减少腰椎术后硬膜及神经根周围的纤维化与粘连,提高腰椎间盘突出症二次手术的临床疗效。     

Anatomic evaluation of two different techniques for the percutaneous insertion of pedicle screws in the lumbar spine.

STUDY DESIGN: An in vitro study in which a human cadaver model was used to examine the accuracy of two different techniques of percutaneous pedicle screw insertion in the lumbar spine. OBJECTIVES: To investigate the in vitro misplacement rate of pedicle screw insertion for two different percutaneous techniques: 1) the well established Magerl technique, and 2) a new modified technique. SUMMARY OF BACKGROUND DATA: Numerous anatomic and biomechanical studies have been conducted to analyze the in vitro and in vivo characteristics of pedicle screw insertion in the lumbar spine via an open approach, whereas there is a lack of experimental data concerning the more sophisticated percutaneous procedure. METHODS: Thirty human specimens from L1 to S1 were separated into two groups (A and B). In group A, the screws were placed in accordance with the technique described by Magerl; in group B, a new modified technique developed by the authors' research group was used. After screw placement, the specimens were dissected, and pedicle violations were noted with respect to the degree and direction of the screw misplacement. RESULTS: The dissection of the specimens showed that of 360 pedicle screws, 37 were misplaced. This finding translates into an overall misplacement rate of 10%. With the Magerl technique, 23 pedicle violations (misplacement rate, 13%) were found; with the modified technique, only 14 dislocated pedicle screws (misplacement rate, 8%) were detected. This difference was not statistically significant (P = 0.118). In both groups, there were significantly more medical pedicle violations than lateral (32 medial and 5 lateral screw dislocations). The degree of the screw misplacements varied between 1.0 and 5.0 mm. The majority of pedicle violations (30 of 37) were minor, i.e., less than 3.0 mm. CONCLUSIONS: This in vitro study showed that the percutaneous technique of pedicle screw insertion in the lumbar spine is a safe and reliable procedure. Compared with the well-established Magerl technique, the new modified technique did not decrease the misplacement rate significantly, although less pedicle violations were found in the upper lumbar spine.     

Anatomic evaluation and relationship between the lumbar pedicle and adjacent neural structures: an anatomic study

OBJECTIVE: Transpedicular spinal fixation has recently been the focus of increased attention in several institutions throughout the world, but its safety and efficacy are still important questions for orthopedic surgeons. Accurate screwing through the pedicle will avoid neurologic complications and increase the stability of the instrumentation. In this study, it was aimed to analyze the anatomic relations quantitatively between the lumbar pedicle and the adjacent dural sac and nerve roots, to determine the risky areas for neural injury during transpedicular screw placement. METHODS: Ten adult cadavers were used for observation of the lumbar pedicle and its relations. After removal of the laminas and facets, the lumbar pedicles, dural sac, and nerve roots were exposed. Interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), and pedicle-dural sac distance (PDSD) were measured. RESULTS: Average distance from the lumbar pedicle to the dural sac medially and to the adjacent nerve roots superiorly and inferiorly through the cranial to caudal lumbar levels ranged from 1.29 to 1.56, from 4.12 to 5.52, and from 1.10 to 1.06 mm, respectively. The mean IPD ranged from 32.77 to 41.24 mm. There were statistically significant differences between the L5 level and other lumbar levels for IPD, PSRD, and PDSD measurements. CONCLUSIONS: These results indicate that although L5 is safer than other lumbar levels for pedicle screw insertion, an improper medial and caudal placement of a pedicular screw will carry a great risk of injury to the dural sac and inferior nerve root.     

Anatomic observation and clinical significance of vertebral pedicle

To be aware of the security in fixing the spine through posterior approach with instrumentation, a study of the regional anatomy of the pedicle was done by measuring various parameters in 51 thoraco-lumbar (T-9 to L-3) specimens, including the thickness, height, and length of pedicle, the angles made by line of the pedicle axis with both the sagittal and longitudinal lines of the same vertebral body, and the distance between pedicles of each vertebra. The space between spinal cord and pedicles on cross section of 35 cadaveral specimens was also measured. For purpose of comparison to find out the anatomical significance for clinical application, measurement of corresponding parameters on CT scan films of 50 cases were carried out. Taking into account of all these parameters, findings and some clinical experience, detailed discussion about operative indications, procedures of internal fixation and the inserting point along with the direction of drilling screws in were made.     

螺旋CT三维测量在腰椎椎弓根置钉中的应用研究

目的:探索螺旋CT三维测量(SCT-3DM)引导腰椎椎弓根螺钉置入的有效方法。方法:取成人腰椎干骨标本(L1～L5)5具,各沿棘突髓腔插入钛合金定位针(针尾外露);行螺旋CT连续容积扫描,资源图像输入AW4.0工作站作多平面重组(MPR)、最大密度投影(MIP)及表面遮盖显示(SSD)等重建,并测量根针距(PND)、根轴距(PAD)及矫正角(PRA)、根轴角(PAA);并将5具标本作实体解剖测量,对照分析两种测量结果的统计学差异。结果:三维测量结果与实体解剖测量比较呈高相关性(均为γ>0.99)。临床应用此方法经腰椎椎弓根置钉30例,有效性为100%。结论:一针法定位及SCT-3DM对腰椎椎弓根螺钉的置入有重要实用价值。     

带棘突钛钉腰椎弓根螺旋CT三维测量的解剖学研究及临床应用

目的 :探索带棘突钛钉腰椎螺旋CT三维测量 (SCT 3DM)引导经腰椎弓根手术定位的准确性。方法 :取成人腰椎干骨标本 (L1～L5) 10具 ,沿棘突髓腔插入钛合金定位钉 (针尾外露 ) :行螺旋CT连续容积扫描 ,资源图像输入AW 4.0工作站做多平面重组 (MPR)、最大密度投影 (MIP)及表面遮盖显示(SSD)等重建 ,测量根针距 (PND)、根轴距 (PAD)及SSA角的矫正角 (PRA)、根轴角 (TSA) ;并将 10具标本做实体解剖观察 ,对照两种测量结果的有效性。临床应用三维重建椎体显示后部分结构 ,以横突平分线和上关节突外缘线为坐标 ,显示位于根针距、根轴距、矫正角及根轴角 (TSA)方向的椎弓根后缘坐标点。结果 :三维测量结果与实体解剖测量比较呈高相关性 (γ >0 .99) ,临床应用经椎弓根手术 2 0例 ,有效性为 10 0 %。结论 :经棘突钛钉定位及SCT 3DM可有效地指导经腰椎弓根定位手术。     

腰椎经皮椎弓钉皮质轨迹置入的影像解剖测量

[目的]测量中老年人腰椎经皮椎弓根皮质骨螺钉的解剖学参数并分析其经皮置钉可行性.[方法]选取50例中老年人腰椎三维CT资料并导入Aquarius iNtuition Viewer V 4.4.6软件,测量各节段皮质骨螺钉置钉横断面与矢状面的进钉角度、安全范围、钉道直径及长度、螺钉轨迹皮肤进钉点至椎体上终板的距离和进钉点...     

肝蒂横断式肝切除在解剖性肝中叶切除术中的应用

目的:评价采用肝蒂横断式肝切除术行解剖性肝中叶切除的安全性和有效性。方法:51例肝中叶原发性肝癌患者按频数匹配原则随机分为传统手术组(n=30)和肝蒂横断式肝切除组(n=21),观察比较两组手术时间、手术失血量、术后肝功能、住院时间、并发症发生率及预后等情况。结果:肝蒂横断式肝切除组与传统手术组比较,手术时间短[(2.7±0.839)h vs.(4.5±0.952)h],术中出血量少[(406±33.182)mL vs.(793±29.677)mL],术后肝功能恢复快[术后7 dALT为(63.048±7.513)U/L vs.(323.667±12.939)U/L],住院时间缩短[(12.528±0.245)d vs.(16.733±0.338)d],并发症发生率低(14.2%vs.40.0%),术后1年肿瘤复发率低[4.8%(1/21)vs.26.7%(8/30)],差异均有统计学意义(均P<0.05)。结论:应用肝蒂横断式肝切除技术行解剖性肝中叶切除安全、有效、微创,值得推广。