上胸椎前路逆向椎弓根及逆向椎弓根—肋骨复合体镙钉技术的可行性研究
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摘要
第一部分：上胸椎前路逆向椎弓根螺钉内固定技术的相关放射解剖学研究
目的：对上胸椎(T1-T4)进行放射解剖学方面的观察、测量,为上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉内固定技术提供理论依据。
方法：对层厚为0.625mm的上胸椎薄层CT扫描数据进行MPR重建,在椎弓根轴心上选取每侧椎弓根的横切面和矢状面进行观察和测量,测出每侧椎弓根的横径、高度、横切面上进钉点距离(横切面上进钉点距椎体正中矢状线的距离)、横切面进钉角度、矢状面进钉点距离(矢状面上进钉点距上终板的距离)、矢状面进钉角度和钉道长度的数据,对数据进行统计学处理,从而得出相关数据。
结果：T1-T4椎弓根横径逐渐减小3.47～8.14mm；椎弓根高度逐渐增大6.89～10.29mmm;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1.80～5.50mmm；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。
结论：上胸逆向椎弓根螺钉直径的选择取决于椎弓根的横径,T1、T2可以从椎体前方逆向植入直径为4.Omm左右的椎弓根螺钉,T3、T4不适合从椎体前方逆向植入椎弓根螺钉,但可以将直径为5.Omm左右的椎弓根螺钉从椎体前方逆向植入到椎弓根-肋骨复合体中,上胸椎逆向椎弓根及逆向椎弓根-肋骨复合体螺钉可以突破后方骨皮质达到双皮质固定的目的。
第二部分：徒手操作下上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉植入的安全性及可行性研究
目的：在第一部分结果指导下,通过标本上徒手模拟手术操作,验证上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉内固定技术的安全性及可行性。
方法：在成人上胸椎防腐尸体标本上以第一部分研究中测量所得数据为指导,徒手于标本T1、T2椎体前方逆向植入椎弓根螺钉,从T3、T4椎体前方逆向植入椎弓根-肋骨复合体螺钉,通过X线透视、CT扫描,最后取出螺钉,沿钉道方向进行横断面和矢状面的解剖,在剖面上观察、测量、评价置钉的成功率。
结果：共40个椎体,80侧椎弓根,根据本次实验制定的判断标准,T1、2前路逆向椎弓根螺钉成功33侧,失败7侧,成功率82.5%；T3、4前路逆向椎弓根-肋骨复合体螺钉成功32例,失败8例,成功率80%。
结论：T1、T2椎体前路逆向椎弓根螺钉技术,T3、T4椎体前路逆向椎弓根-肋骨复合体螺钉技术是安全可行的,但T1、T2椎体在同一横截面上只能单侧植入逆向椎弓根螺钉。
第三部分：CT三维导航辅助下上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的可行性及安全性研究
目的：通过在标本上模拟手术操作来证实CT三维导航辅助下上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的可行性及安全性。
方法：在CT三维导航技术辅助下,在成人上胸椎防腐尸体标本上模拟手术置钉,于标本T1、T2椎体前方逆向植入椎弓根螺钉,于T3、T4椎体前方逆向植入椎弓根-肋骨复合体螺钉,通过X线透视、CT扫描,最后取出螺钉,沿钉道方向进行横断面和矢状面的解剖,在剖面上观察、测量、评价置钉的成功率。
结果：共40个椎体,80侧椎弓根,根据本次实验制定的判断标准,T1、2前路逆向椎弓根螺钉成功39侧,失败1侧,成功率97.5%；T3、4前路逆向椎弓根-肋骨复合体螺钉成功38例,失败2例,成功率95%。相对于徒手操作置钉准确率明显提高,统计学差异有显著性。
结论：CT三维导航技术可以用于辅助上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉的植入,与徒手操作相比,该技术可以提高上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的准确性及安全性。
Part Ⅰ:Radiographic Anatomy Study of the Anterior Transpedicular Screw Fixation Techniques at Upper Thoracic Spine
Objective:To provide a theoretical basis of the ATPS techniques at upper thoracic spine (T1～T4) by means of radiographic anatomy study.
Methods:The thin-section CT scan data(which thickness is0.6mm) of the upper thoracic spine were reconstructed, select the transverse and sagittal sections on the axis of each pedicle. Observe and measure the OPW, OPH, PAL, TPA, SPA, DTIP and DSIP of each pedicle of the upper thoracic vertebrae. Then, the relevant data was obtained by means of statistical processing.
Results:From T1to T4, the OPW decrease gradually, from3.47mm to8.14mm; the OPH increase gradually from6.89mm to10.29mm; the TPA decrease gradually, from32.96°to11.64°; the DTIP increase gradually from1.80mm to5.50mm; the SPA increase gradually from104.95°to115.74°; the DSIP increase gradually from5.95to8.76mm; the PAL changes irregularly, from32.95to35.96mm.
Conclusion:The diameter of ATPS of the upper thoracic vertebrae depends on the OPW; at T1and T2, the ATPS whose diameter is about4.0mm can be implanted successfully. The ATPS isn't fit for T3and T4, but the ATPRS whose diameter is about5.0mm can be implanted successfully at T3and T4. In order to achieve the bicortical fixed purpose, the length of screw can be so long that it can through out the rear bone cortex.
Part Ⅱ:The Safety and Feasibility Study of the Anterior Transpedicular Screw and Anterior Trans Pedicle-rib Unit Screw Implementation at Upper Thoracic Spine by Free Hand
Purpose:To investigate the safety and feasibility of the ATPS and ATPRS fixation techniques by means of free hand analog operation on cadaveric specimens in the guidance of result in part I.
Methods:In the guidance of result in part I, using adult antiseptic cadaveric upper thoracic specimens, ATPS were implanted at T1and T2, ATPRS were implanted at T3and T4by free hand. After that the specimens accepted X-ray fluoroscopy and CT scans. At last, the screws were removed, the specimens were sawed along the transaction and sagittal section of the screw channel. The success rate of the screws'implantation was evaluated by means of X-ray fluoroscopy, CT scans and observation and measurement at transaction and sagittal section.
Results:There were40vertebraes and80pedicles, according to the criteria for this experiment,33ATPS were implanted at T1and T2successfully,7ATPS were failed, the success rate was82.5%.32ATPRS were implanted at T1and T2successfully,8ATPRS were failed, the success rate was80%.
Conclusion:At T1and T2, the ATPS can be implanted safely. At T3and T4, the ATPRS can be implanted safely. The DTIP was too narrow at T1and T2, that the ATPS can be implanted only at one side.
Part Ⅲ:The Safety and Feasibility Study of the Anterior Transpedicular Screw and Anterior Trans Pedicle-rib Unit Screw Implantation at Upper Thoracic Spine in the Guidance of CT3D Navigation
Purpose:To investigate the safety and feasibility of the ATPS and ATPRS fixation techniques at upper thoracic spine by means of analog operation on cadaveric specimens in the guidance of CT3D navigation.
Methods:In the guidance of CT3D navigation, using adult antiseptic cadaveric upper thoracic specimens, ATPS were implanted at T1and T2, ATPRS were implanted at T3and T4. After that the specimens accepted X-ray fluoroscopy and CT scans. At last, the screws were removed, the specimens were sawed along the transaction and sagittal section of the screw channel. The success rate of the screws'implantation was evaluated by means of X-ray fluoroscopy, CT scans and observation and measurement at transaction and sagittal section.
Results:There were40vertebraes and80pedicles, according to the criteria for this experiment,39ATPS were implanted at T1and T2successfully,1ATPS were failed, the success rate was97.5%.38ATPRS were implanted at T3and T4successfully,2ATPRS were failed, the success rate was95%. The accuracy of screw placement is significantly improved compared to the free-hand operation, the statistical difference is significant.
Conclusion:CT3D navigation technology can be used for the implantation of ATPS and ATPRS at upper thoracic spine. It can significantly improve the accuracy of screw placement compared to the free-hand operation.
目的：对上胸椎(T1-T4)进行放射解剖学方面的观察、测量,为上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉内固定技术提供理论依据。
方法：对层厚为0.625mm的上胸椎薄层CT扫描数据进行MPR重建,在椎弓根轴心上选取每侧椎弓根的横切面和矢状面进行观察和测量,测出每侧椎弓根的横径、高度、横切面上进钉点距离(横切面上进钉点距椎体正中矢状线的距离)、横切面进钉角度、矢状面进钉点距离(矢状面上进钉点距上终板的距离)、矢状面进钉角度和钉道长度的数据,对数据进行统计学处理,从而得出相关数据。
结果：T1-T4椎弓根横径逐渐减小3.47～8.14mm；椎弓根高度逐渐增大6.89～10.29mmm;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1.80～5.50mmm；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。
结论：上胸逆向椎弓根螺钉直径的选择取决于椎弓根的横径,T1、T2可以从椎体前方逆向植入直径为4.Omm左右的椎弓根螺钉,T3、T4不适合从椎体前方逆向植入椎弓根螺钉,但可以将直径为5.Omm左右的椎弓根螺钉从椎体前方逆向植入到椎弓根-肋骨复合体中,上胸椎逆向椎弓根及逆向椎弓根-肋骨复合体螺钉可以突破后方骨皮质达到双皮质固定的目的。
第二部分：徒手操作下上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉植入的安全性及可行性研究
目的：在第一部分结果指导下,通过标本上徒手模拟手术操作,验证上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉内固定技术的安全性及可行性。
方法：在成人上胸椎防腐尸体标本上以第一部分研究中测量所得数据为指导,徒手于标本T1、T2椎体前方逆向植入椎弓根螺钉,从T3、T4椎体前方逆向植入椎弓根-肋骨复合体螺钉,通过X线透视、CT扫描,最后取出螺钉,沿钉道方向进行横断面和矢状面的解剖,在剖面上观察、测量、评价置钉的成功率。
结果：共40个椎体,80侧椎弓根,根据本次实验制定的判断标准,T1、2前路逆向椎弓根螺钉成功33侧,失败7侧,成功率82.5%；T3、4前路逆向椎弓根-肋骨复合体螺钉成功32例,失败8例,成功率80%。
结论：T1、T2椎体前路逆向椎弓根螺钉技术,T3、T4椎体前路逆向椎弓根-肋骨复合体螺钉技术是安全可行的,但T1、T2椎体在同一横截面上只能单侧植入逆向椎弓根螺钉。
第三部分：CT三维导航辅助下上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的可行性及安全性研究
目的：通过在标本上模拟手术操作来证实CT三维导航辅助下上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的可行性及安全性。
方法：在CT三维导航技术辅助下,在成人上胸椎防腐尸体标本上模拟手术置钉,于标本T1、T2椎体前方逆向植入椎弓根螺钉,于T3、T4椎体前方逆向植入椎弓根-肋骨复合体螺钉,通过X线透视、CT扫描,最后取出螺钉,沿钉道方向进行横断面和矢状面的解剖,在剖面上观察、测量、评价置钉的成功率。
结果：共40个椎体,80侧椎弓根,根据本次实验制定的判断标准,T1、2前路逆向椎弓根螺钉成功39侧,失败1侧,成功率97.5%；T3、4前路逆向椎弓根-肋骨复合体螺钉成功38例,失败2例,成功率95%。相对于徒手操作置钉准确率明显提高,统计学差异有显著性。
结论：CT三维导航技术可以用于辅助上胸椎前路逆向椎弓根及逆向椎弓根-肋骨复合体螺钉的植入,与徒手操作相比,该技术可以提高上胸椎前路逆向椎弓根螺钉及逆向椎弓根-肋骨复合体螺钉植入的准确性及安全性。
Part Ⅰ:Radiographic Anatomy Study of the Anterior Transpedicular Screw Fixation Techniques at Upper Thoracic Spine
Objective:To provide a theoretical basis of the ATPS techniques at upper thoracic spine (T1～T4) by means of radiographic anatomy study.
Methods:The thin-section CT scan data(which thickness is0.6mm) of the upper thoracic spine were reconstructed, select the transverse and sagittal sections on the axis of each pedicle. Observe and measure the OPW, OPH, PAL, TPA, SPA, DTIP and DSIP of each pedicle of the upper thoracic vertebrae. Then, the relevant data was obtained by means of statistical processing.
Results:From T1to T4, the OPW decrease gradually, from3.47mm to8.14mm; the OPH increase gradually from6.89mm to10.29mm; the TPA decrease gradually, from32.96°to11.64°; the DTIP increase gradually from1.80mm to5.50mm; the SPA increase gradually from104.95°to115.74°; the DSIP increase gradually from5.95to8.76mm; the PAL changes irregularly, from32.95to35.96mm.
Conclusion:The diameter of ATPS of the upper thoracic vertebrae depends on the OPW; at T1and T2, the ATPS whose diameter is about4.0mm can be implanted successfully. The ATPS isn't fit for T3and T4, but the ATPRS whose diameter is about5.0mm can be implanted successfully at T3and T4. In order to achieve the bicortical fixed purpose, the length of screw can be so long that it can through out the rear bone cortex.
Part Ⅱ:The Safety and Feasibility Study of the Anterior Transpedicular Screw and Anterior Trans Pedicle-rib Unit Screw Implementation at Upper Thoracic Spine by Free Hand
Purpose:To investigate the safety and feasibility of the ATPS and ATPRS fixation techniques by means of free hand analog operation on cadaveric specimens in the guidance of result in part I.
Methods:In the guidance of result in part I, using adult antiseptic cadaveric upper thoracic specimens, ATPS were implanted at T1and T2, ATPRS were implanted at T3and T4by free hand. After that the specimens accepted X-ray fluoroscopy and CT scans. At last, the screws were removed, the specimens were sawed along the transaction and sagittal section of the screw channel. The success rate of the screws'implantation was evaluated by means of X-ray fluoroscopy, CT scans and observation and measurement at transaction and sagittal section.
Results:There were40vertebraes and80pedicles, according to the criteria for this experiment,33ATPS were implanted at T1and T2successfully,7ATPS were failed, the success rate was82.5%.32ATPRS were implanted at T1and T2successfully,8ATPRS were failed, the success rate was80%.
Conclusion:At T1and T2, the ATPS can be implanted safely. At T3and T4, the ATPRS can be implanted safely. The DTIP was too narrow at T1and T2, that the ATPS can be implanted only at one side.
Part Ⅲ:The Safety and Feasibility Study of the Anterior Transpedicular Screw and Anterior Trans Pedicle-rib Unit Screw Implantation at Upper Thoracic Spine in the Guidance of CT3D Navigation
Purpose:To investigate the safety and feasibility of the ATPS and ATPRS fixation techniques at upper thoracic spine by means of analog operation on cadaveric specimens in the guidance of CT3D navigation.
Methods:In the guidance of CT3D navigation, using adult antiseptic cadaveric upper thoracic specimens, ATPS were implanted at T1and T2, ATPRS were implanted at T3and T4. After that the specimens accepted X-ray fluoroscopy and CT scans. At last, the screws were removed, the specimens were sawed along the transaction and sagittal section of the screw channel. The success rate of the screws'implantation was evaluated by means of X-ray fluoroscopy, CT scans and observation and measurement at transaction and sagittal section.
Results:There were40vertebraes and80pedicles, according to the criteria for this experiment,39ATPS were implanted at T1and T2successfully,1ATPS were failed, the success rate was97.5%.38ATPRS were implanted at T3and T4successfully,2ATPRS were failed, the success rate was95%. The accuracy of screw placement is significantly improved compared to the free-hand operation, the statistical difference is significant.
Conclusion:CT3D navigation technology can be used for the implantation of ATPS and ATPRS at upper thoracic spine. It can significantly improve the accuracy of screw placement compared to the free-hand operation.
引文
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