根据腰椎神经根解剖结构确定重建人工椎体椎弓根螺钉的置钉位置
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摘要
背景:对于全后路椎体切除术后重建脊柱结构的完整性,人工椎体无疑是最好的选择。但目前椎体与椎弓根之间没有连接结构,常常发生椎体的移位,带来严重的并发症。目的:探索腰椎神经根解剖位置对人工椎体椎弓根螺钉放置的影响。方法:选取10具新鲜冷冻的尸体,排除重大的腰椎疾病及手术史。切除椎板、部分椎弓根和黄韧带,标记并测量解剖位置,探索椎弓根钉的最佳位置。结果与结论:(1)所测量椎体之间的高度各不同,各椎体之间差异有显著性意义(P <0.05);(2)但在椎弓根连线上,神经根中点与上位椎体下终板及下位椎体上终板之间的比率恒定,男女之间差异无显著性意义(P>0.05),L1-5节段之间差异也无显著性意义(P> 0.05);(3)腰椎椎体完全切除后,腰椎人工椎体椎弓根螺钉的最佳置钉位置在神经根中点与上位椎体下的中心,即人工椎体高度的中上1/3左右。
BACKGROUND: Artificial vertebra is the best choice for the reconstruction of the spinal structure after posterior total laminectomy. However, there is no connection between the vertebral body and the vertebral pedicle, and vertebral body displacement often occurs, resulting in serious complications. OBJECTIVE: To explore the effect of anatomical position of lumbar nerve root on the pedicle screw placement of the artificial vertebral body. METHODS: Ten fresh frozen cadavers were selected, excluding major lumbar diseases and operation history.After the laminectomy and removal of partial pedicle and ligamentum flavum, we marked and measured the anatomical position. The best position of pedicle screw was explored.RESULTS AND CONCLUSION:(1) The height of the vertebral body measured was significantly different(P < 0.05).(2) However, on the pedicle line, the ratio of the distance between the midpoint of the nerve root to the lower endplate of the upper vertebral body and the upper endplate of the lower vertebra was constant. There was no significant difference between males and females(P > 0.05). There was no significant difference among L1-5 segments(P > 0.05).(3) After complete laminectomy, the best position of the lumbar pedicle screw is at the center of the middle of the nerve root and the lower endplate of the upper vertebral body, that is, the middle and upper 1/3 of the height of the artificial vertebral body.
BACKGROUND: Artificial vertebra is the best choice for the reconstruction of the spinal structure after posterior total laminectomy. However, there is no connection between the vertebral body and the vertebral pedicle, and vertebral body displacement often occurs, resulting in serious complications. OBJECTIVE: To explore the effect of anatomical position of lumbar nerve root on the pedicle screw placement of the artificial vertebral body. METHODS: Ten fresh frozen cadavers were selected, excluding major lumbar diseases and operation history.After the laminectomy and removal of partial pedicle and ligamentum flavum, we marked and measured the anatomical position. The best position of pedicle screw was explored.RESULTS AND CONCLUSION:(1) The height of the vertebral body measured was significantly different(P < 0.05).(2) However, on the pedicle line, the ratio of the distance between the midpoint of the nerve root to the lower endplate of the upper vertebral body and the upper endplate of the lower vertebra was constant. There was no significant difference between males and females(P > 0.05). There was no significant difference among L1-5 segments(P > 0.05).(3) After complete laminectomy, the best position of the lumbar pedicle screw is at the center of the middle of the nerve root and the lower endplate of the upper vertebral body, that is, the middle and upper 1/3 of the height of the artificial vertebral body.
引文
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[19]Yu T,Mi S,He Y,et al.Accuracy of pedicle screw placement in posterior lumbosacral instrumentation by computer tomography evaluation:A multi-centric retrospective clinical study.Int J Surg.2017;43:46-51.
[20]陈家强,周立兵,余明华,等.胸腰椎椎弓根的解剖学测量及其临床意义[J].解剖学研究,2004,26(1):63-65.
[21]Akhgar J,Terai H,Rahmani MS,et al.Anatomical analysis of the relation between human ligamentum flavum and posterior spinal bony prominence.J Orthop Sci.2017;22(2):260-265.
[22]吴波,赵庆豪,周潇齐,等.腰椎间孔镜的应用解剖[J].中国临床解剖学杂志,2017,35(1):5-8.
[23]吴祖耀,刘建华,杨国良,等.腰_(4/5)节段椎间孔镜经不同手术入路的应用解剖[J].解剖学研究,2016,38(5):396-399.
[24]Kim CH,Chung CK,Sohn S,et al.The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation.J Spinal Disord Tech.2014;27(8):415-422.
[25]谢长伟.经皮椎间孔镜与传统手术在老年性腰椎管狭窄症治疗中的效果比较[J].河南医学研究,2018,27(13):2417-2418.
[26]Choi KC,Shim HK,Hwang JS,et al.Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation.World Neurosurg.2016;116:e750-e758.
[27]Gibson JN,Subramanian AS,Scott CEH.A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.Eur Spine J.2017;26(8):847-856.
[2]Shah AA,Paulino Pereira NR,Pedlow FX,et al.Modified en bloc spondylectomy for tumors of the thoracic and lumbar spine:surgical technique and outcomes.J Bone Joint Surg Am.2017;99(17):1476-1484.
[3]刘俭涛,张峰,高正超,等.人工椎体的发展与应用[J].中国骨伤,2017,30(12):1157-1164.
[4]Altaf F,Weber M,Dea N,et al.Evidence-based review and survey of expert opinion of reconstruction of metastatic spine tumors.Spine(Phila Pa 1976).2016;41 Suppl 20:S254-S261.
[5]Viswanathan A,Abd-El-Barr MM,Doppenberg E,et al.Initial experience with the use of an expandable titanium cage as a vertebral body replacement in patients with tumors of the spinal column:a report of 95 patients.Eur Spine J.2012;21:84-92.
[6]Glennie RA,Rampersaud YR,Boriani S,et al.A systematic review with consensus expert opinion of best reconstructive techniques after osseous en bloc spinal column tumor resection.Spine(Phila Pa 1976).2016;41 Suppl 20:S205-S211.
[7]姚仕奋,王昊,陈锦标,等.后路一期全椎体切除脊柱重建术治疗39例胸腰段脊柱肿瘤分析[J].肿瘤学杂志,2018,24(2):171-174.
[8]孙俊刚,肖伟,王浩,等.一期经后路全脊椎整块切除术治疗胸腰椎肿瘤[J].临床骨科杂志,2015,18(4):390-393.
[9]de Ruiter GC,Lobatto DJ,Wolfs JF,et al.Reconstruction with expandable cages after single-and multilevel corpectomies for spinal metastases:a prospective case series of 60patients.Spine J.2014;14:2085-2093.
[10]Domenicucci M,Nigro L,Delfini R.Total en-bloc spondylectomy through a posterior approach:technique and surgical outcome in thoracic metastases.Acta Neurochirurgica.2018;160(7):1373-1376.
[11]Modi HN,Suh SW,Hong JY,et al.Treatment and complications in flaccid neuromuscular scoliosis(Duchenne muscular dystrophy and spinal muscular atrophy)with posterior-only pedicle screw instrumentation.Eur Spine J.2010;19:384-393.
[12]Alfieri A,Gazzeri R,Neroni M,et al:Anterior expandable cylindrical cage reconstruction after cervical spinal metastasis resection.Clin Neurol Neurosurg.2011;113:914-917.
[13]Sangsin A,Murakami H,Shimizu T,et al.Four-year survival of a patient with spinal metastatic acinic cell carcinoma after a total en bloc spondylectomy and reconstruction with a frozen tumor-bearing bone graft.Orthopedics.2018;41(5):e727-e730.
[14]Ackerman DB,Rose PS,Moran SL,et al.The results of vascularizedfree fibular grafts in complex spinal reconstruction.J Spinal Disord Tech.2011;24:170-176.
[15]Dea N,Charest-Morin R,Sciubba DM,et al.Optimizing the adverse event and hrqol profiles in the management of primary spine tumors.Spine(Phila Pa 1976).2016;41 Suppl20:S212-S217
[16]Fan Y,Xia Y,Zhao H,et al.Complications analysis of posterior vertebral column resection in 40 patients with spinal tumors.Exp Ther Med.2014;8:1539-1544.
[17]管喆恒,杨惠林,罗宗平,等.腰椎椎弓根CT影像学参数的测量与临床意义[J].中国组织工程研究,2018,22(11):1743-1748.
[18]Sak??Z,Onen MR,Naderi S.The radiological distance between the lumbar pedicle and laminar edges.Surg Radiol Anat.2017;39(11):1249-1252.
[19]Yu T,Mi S,He Y,et al.Accuracy of pedicle screw placement in posterior lumbosacral instrumentation by computer tomography evaluation:A multi-centric retrospective clinical study.Int J Surg.2017;43:46-51.
[20]陈家强,周立兵,余明华,等.胸腰椎椎弓根的解剖学测量及其临床意义[J].解剖学研究,2004,26(1):63-65.
[21]Akhgar J,Terai H,Rahmani MS,et al.Anatomical analysis of the relation between human ligamentum flavum and posterior spinal bony prominence.J Orthop Sci.2017;22(2):260-265.
[22]吴波,赵庆豪,周潇齐,等.腰椎间孔镜的应用解剖[J].中国临床解剖学杂志,2017,35(1):5-8.
[23]吴祖耀,刘建华,杨国良,等.腰_(4/5)节段椎间孔镜经不同手术入路的应用解剖[J].解剖学研究,2016,38(5):396-399.
[24]Kim CH,Chung CK,Sohn S,et al.The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation.J Spinal Disord Tech.2014;27(8):415-422.
[25]谢长伟.经皮椎间孔镜与传统手术在老年性腰椎管狭窄症治疗中的效果比较[J].河南医学研究,2018,27(13):2417-2418.
[26]Choi KC,Shim HK,Hwang JS,et al.Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation.World Neurosurg.2016;116:e750-e758.
[27]Gibson JN,Subramanian AS,Scott CEH.A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.Eur Spine J.2017;26(8):847-856.