• 成都大學(xué)附屬醫(yī)院骨科（成都，610081）;

【摘要】　目的　 研究棘突頂端上下緣與椎弓根中心點水平面垂直距離的關(guān)系，為微創(chuàng)胸腰段脊柱內(nèi)固定術(shù)椎弓根的體表定位提供實驗依據(jù)。　方法　 20具完整脊柱骨標(biāo)本，測量標(biāo)本兩側(cè)胸11~腰2椎弓根中心點與棘突旁開距離（CO）、棘突上、下緣至椎弓根中心點水平面垂直距離（AC、BC），以棘突頂端的上、下緣為參照點確定椎弓根的最佳體表投影點。選取20例無神經(jīng)癥狀的單節(jié)段椎體骨折男性患者；年齡23~54歲，平均37.6歲。損傷部位:胸11、胸12、腰1、腰2骨折椎體各5例。以棘突頂端上緣點為確定椎弓根中心的參考點，行經(jīng)皮椎弓根螺釘固定，分別測定術(shù)前、術(shù)后相應(yīng)椎體Cobb角。　結(jié)果　 男、女性各椎體左右兩側(cè)CO、AC、BC比較差異均無統(tǒng)計學(xué)意義（P gt;0.05）。男女組間相同椎體CO和BO及胸11、胸12椎體的AC比較差異均有統(tǒng)計學(xué)意義（P lt;0.05），腰1、腰2椎體的AC比較差異無統(tǒng)計學(xué)意義（P gt;0.05）。男性或女性胸11~腰2的CO依次變大、AC和BC逐漸減小，各椎體間比較差異均有統(tǒng)計學(xué)意義（P lt;0.01）。臨床應(yīng)用顯示，術(shù)前、術(shù)后相應(yīng)椎體Cobb角比較，差異均有統(tǒng)計學(xué)意義（P lt;0.05）。　結(jié)論　 棘突頂端上緣為確定椎弓根中心點的最佳參照點，微創(chuàng)脊柱內(nèi)固定術(shù)體表定位椎弓根時應(yīng)根據(jù)性別和具體骨折椎體確定進(jìn)針點。
【Abstract】　Objective　 To study the anatomic distances from the upper and lower edges of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch, to provide assistance for the percutaneous positioning of the pedicle of vertebral arch in minimally-invasive transpedicular internal fixation for the thoracic and lumbar vertebrae. 　Methods　 We studied 20 integral thoraco-lumbar vertebrae samples, and the distance between the vertical plane including the upper and lower points of the spinous process peak and the horizontal plane of the center of pedicle of vertebral arch was measured and marked as CO. We also measured the distances from the upper and lower points of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch and marked them as AC and BC respectively. The upper and lower points of the spinous process peak were designated as reference points to define the optimal body surface projective point of the pedicle of vertebral arch. Twenty male patients with single segmental fractured vertebral body and without nervous symptoms were selected. The age of the patients were ranged from 23 to 54 years old, averaging at 37.6. The fractured vertebral bodies included T11, T12, L1, and L2 with 5 cases for each of them. The percutaneous transpedicular internal fixation was carried out with the upper point of the spinous process peak as the reference point to define the body surface projective point of the pedicle of vertebral arch and the preoperative and postoperative Cobb angle of each fractured vertebral body were measured. 　Results　 There was no significant differences in CO, AC and BC on both sides between male and female (P gt;0.05). Statistical difference existed between male and female in CO and BO of the same vertebra, and AC of T11 and T12 (P lt;0.05), while AC of L1 and L2 had no significant difference (P gt;0.05). In both males and females, CO of the vertebrae from T11 to L2 increased, while AC and BC decreased, and there was a significant difference among different vertebrae (P lt;0.01). Clinical application showed there was a significant difference between the Cobb angle before operation and that after operation (P lt;0.05). 　Conclusion　 The upper point of the spinous process peak is the best reference point to define the center of pedicle of vertebral arch. Deciding on the needle insertion spot should be based on gender and specific vertebral body, when minimally-invasive transpedicular internal fixation is performed to define the body surface projective point of the pedicle of vertebral arch.

引用本文： 李開南,汪學(xué)軍,張進(jìn)軍,何志勇,母建松,蘭海,鄭江. 微創(chuàng)脊柱手術(shù)時椎弓根的體表定位解剖及臨床應(yīng)用. 華西醫(yī)學(xué), 2011, 26(5): 684-687. doi: 復(fù)制

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1. 　Lee HM, Kim NH, Kim HJ, et al. Morphometric study of the lumbar spinal canal in the Korean population [J]. Spine(Phila Pa 1976), 1995, 20(15): 1679-1684.
2. 　Tacar O, Demirant A, Nas K, et al. Morphology of the lumbar spinal canal in normal adult Turks[J]. Yonsei Med J, 2003, 44(4): 679-685.
3. 　李偉, 劉靖, 高豫中, 等. 國人椎管的測量與分析[J]. 中醫(yī)正骨, 2001, 13(6): 11-12.
4. 　柏惠英, 陳文英, 戴棣華, 等. 國人椎管的矢徑與橫徑[J]. 解剖學(xué)報, 1980, 8(3): 261.
5. 　劉淼, 臧家欣, 張一鳴, 等. 腰椎管大小和腰椎管形狀的測量[J]. 中華骨科雜志, 1983, 3: 65-68.
6. 　劉廣杰, 林發(fā)雄, 吳南林, 等. 對腰椎管狹窄癥有關(guān)問題的研究探討[J]. 中華骨科雜志, 1982, 2: 333.
7. 　郭世紱, 陳仲欣, 邱敬清, 等. 腰椎管骨性結(jié)構(gòu)的測量與椎管狹窄[J]. 中華外科雜志, 1984, 2(6): 623.
8. 　Krag MH, Beynnon BD, Pope MH, et al. An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing [J]. Clin Orthop Relat Res, 1986, (203): 75-98.
9. 　Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumber spine with pedicle screw plating [J]. Clin Orthop Relat Res, 1986, (203): 7-17.
10. 　鐘世鎮(zhèn). 骨科臨床解剖學(xué)圖譜[M]. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 2005: 46-49.
11. 　郭開今, 袁峰, 張志明, 等. 腰椎棘突間區(qū)域的應(yīng)用解剖[J]. 江蘇醫(yī)藥, 2006, 6(32): 546-548.
12. 　崔新剛, 張佐倫, 劉建營, 等. 棘突定位法在胸腰椎椎弓根螺釘內(nèi)固定中的應(yīng)用[J]. 中國脊柱脊髓雜志, 2004, 7(14): 429-431.
  1. 1. 　Lee HM, Kim NH, Kim HJ, et al. Morphometric study of the lumbar spinal canal in the Korean population [J]. Spine(Phila Pa 1976), 1995, 20(15): 1679-1684.
  2. 2. 　Tacar O, Demirant A, Nas K, et al. Morphology of the lumbar spinal canal in normal adult Turks[J]. Yonsei Med J, 2003, 44(4): 679-685.
  3. 3. 　李偉, 劉靖, 高豫中, 等. 國人椎管的測量與分析[J]. 中醫(yī)正骨, 2001, 13(6): 11-12.
  4. 4. 　柏惠英, 陳文英, 戴棣華, 等. 國人椎管的矢徑與橫徑[J]. 解剖學(xué)報, 1980, 8(3): 261.
  5. 5. 　劉淼, 臧家欣, 張一鳴, 等. 腰椎管大小和腰椎管形狀的測量[J]. 中華骨科雜志, 1983, 3: 65-68.
  6. 6. 　劉廣杰, 林發(fā)雄, 吳南林, 等. 對腰椎管狹窄癥有關(guān)問題的研究探討[J]. 中華骨科雜志, 1982, 2: 333.
  7. 7. 　郭世紱, 陳仲欣, 邱敬清, 等. 腰椎管骨性結(jié)構(gòu)的測量與椎管狹窄[J]. 中華外科雜志, 1984, 2(6): 623.
  8. 8. 　Krag MH, Beynnon BD, Pope MH, et al. An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing [J]. Clin Orthop Relat Res, 1986, (203): 75-98.
  9. 9. 　Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumber spine with pedicle screw plating [J]. Clin Orthop Relat Res, 1986, (203): 7-17.
  10. 10. 　鐘世鎮(zhèn). 骨科臨床解剖學(xué)圖譜[M]. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 2005: 46-49.
  11. 11. 　郭開今, 袁峰, 張志明, 等. 腰椎棘突間區(qū)域的應(yīng)用解剖[J]. 江蘇醫(yī)藥, 2006, 6(32): 546-548.
  12. 12. 　崔新剛, 張佐倫, 劉建營, 等. 棘突定位法在胸腰椎椎弓根螺釘內(nèi)固定中的應(yīng)用[J]. 中國脊柱脊髓雜志, 2004, 7(14): 429-431.