设计国人直肠后间隙入路轴向腰骶椎融合内固定的影像学测量

发布时间：2019-01-24 19:44

【摘要】：背景:经骶骨前入路的经皮腰骶椎前柱内固定系统即AxiaLIF系统先后在美国及欧洲应用于临床,取得较好的临床疗效。但是国人与欧美人腰骶椎的解剖差异较大,国外内固定系统能否可以直接用于国人尚不明确,且价格昂贵,不适合中国国情,同时该内固定系统在应用过程中出现了一系列的问题,如能优化轴向螺钉设计,该术式在国内将会有更大的推广价值。目的:通过测量国人正常人群腰椎侧位片及腰椎CT L_5、S_1椎体横断面,为设计适合国人的轴向螺钉提供解剖学数据。方法:①选择国人正常成人腰椎侧位片男35例,女30例,分别测量S_1椎体轴向高度、L_5/S_1椎间隙高度、L_5椎体轴向高度,为轴向螺钉的长度设计提供解剖学数据;②选择成人腰椎CT片男26例,女24例,测量腰椎CT L_5、S_1椎体经椎弓根层面的横状径与矢状径,为轴向螺钉的直径设计提供解剖学数据。结果与结论:①国人男、女性腰椎侧位片S_1椎体轴向高度为(26.76±3.94)mm和(22.91±2.91)mm(P0.05)、L_5/S_1椎间隙高度为(12.62±1.90)mm和(11.92±1.78)mm(P0.05)、L_5椎体轴向高度为(29.12±2.18)mm和(26.91±2.47)mm(P0.05);②国人男、女性腰椎CT L_5横状径为(47.34±4.31)mm和(43.12±3.71)mm(P0.05),S_1横状径为(49.18±4.14)mm和(46.11±4.44)mm(P0.05),L_5矢状径为(34.48±2.32)mm和(33.03±3.48)mm(P0.05),S_1矢状径为(35.65±4.28)mm和(33.53±3.26)mm(P0.05);③综上,通过国人腰椎侧位片中轴线及腰椎CT L_5、S_1椎体横断面的测量,可为设计出适合国人腰骶椎融合的轴向螺钉提供解剖数据;根据该影像学测量方法对患者术前影像学资料进行分析,可以预判患者行该手术方式的可行性,并对内固定型号选择做出预估,进行个性化置钉。
[Abstract]:Background: the percutaneous lumbosacral anterior column internal fixation system (AxiaLIF) via the anterior sacral approach has been applied in the United States and Europe respectively. However, the anatomy of lumbosacral vertebrae is quite different between American and Chinese. It is not clear whether the internal fixation system can be directly applied to Chinese people, and it is expensive and not suitable for China's national conditions. At the same time, there are a series of problems in the application of the internal fixation system. If the axial screw design can be optimized, the operation will be more valuable in China. Objective: to provide anatomical data for the design of axial screws in normal Chinese by measuring the lateral radiographs of lumbar vertebrae and the transverse sections of lumbar vertebrae of CT L5S1. Methods: 1Spinal axial height, height of L_5/S_1 intervertebral space, axial height of L5 vertebrae were measured in 35 males and 30 females, respectively. Provide anatomical data for the length design of axial screws; 2 the transverse and sagittal diameters of lumbar vertebrae through pedicle were measured in 26 male and 24 female CT films of adult lumbar vertebrae. The anatomical data were provided for the diameter design of axial screw. Results and conclusion: 1the axial height of lumbar vertebrae in male and female lumbar vertebrae was (26.76 卤3.94) mm and (22.91 卤2.91) mm (, P 0.05), and the axial height was (26.76 卤3.94) mm and (22.91 卤2.91) mm (), respectively. The height of L_5/S_1 intervertebral space was (12.62 卤1.90) mm and (11.92 卤1.78) mm (), and the axial height of L _ (5) vertebrae was (29.12 卤2.18) mm and (26.91 卤2.47) mm (P0.05). 2the transverse diameter of CT L5 in male and female lumbar spine was (47.34 卤4.31) mm and (43.12 卤3.71) mm (, P0.05), and the transverse diameter of S1 was (49.18 卤4.14) mm and (46.11 卤4.44) mm (, P0.05), respectively. The sagittal diameter of L5 was (34.48 卤2.32) mm and (33.03 卤3.48) mm (, P0.05), the sagittal diameter of S-1 was (35.65 卤4.28) mm and (33.53 卤3.26) mm (, P0.05). 3According to the measurement of the lateral axis of the lumbar vertebra and the transverse section of the lumbar vertebrae of CT L5 / S-1, the anatomical data can be provided for the design of the axial screw suitable for the lumbar and sacral fusion of the Chinese. According to the analysis of the preoperative imaging data of the patients, the feasibility of the operation mode can be forecasted, and the selection of the internal fixation model can be predicted, and the individual nailing can be carried out.
【作者单位】：南华大学附属南华医院骨科;
【基金】：湖南省科学技术厅资助项目(2012SK3150)~~
【分类号】：R687.3

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