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[1]盛紅楓,徐衛(wèi)星,盧笛,等.上中胸椎經(jīng)椎弓根-肋骨單元途徑置釘?shù)陌踩约胺�(wěn)定性研究[J].中醫(yī)正骨,2017,29(02):1-5.
　SHENG Hongfeng,XU Weixing,LU Di,et al.Study on the safety and stability of upper-middle thoracic pedicle screw insertion through pedicle rib unit approach[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(02):1-5.
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上中胸椎經(jīng)椎弓根-肋骨單元途徑置釘?shù)陌踩约胺�(wěn)定性研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年02期
頁碼:
1-5
欄目:
基礎(chǔ)研究
出版日期:
2017-02-20

文章信息/Info

Title:
Study on the safety and stability of upper-middle thoracic pedicle screw insertion through pedicle rib unit approach
作者:
盛紅楓; 徐衛(wèi)星; 盧笛; 丁偉國; 許新偉
浙江省立同德醫(yī)院,浙江 杭州 310012
Author(s):
SHENG Hongfeng; XU Weixing; LU Di; DING Weiguo; XU Xinwei
Tongde hospital of Zhejiang province,Hangzhou 310000,Zhejiang,China
關(guān)鍵詞:
胸椎;  椎弓根;  椎弓根-肋骨單元;  骨折固定術(shù); 內(nèi)
Keywords:
thoracic vertebrae;  pedicle of vertebral arch;  pedicle rib unit;  fracture fixation; internal
摘要:
目的:探討上中胸椎經(jīng)椎弓根-肋骨單元(pedicle rib unit,PRU)途徑置釘?shù)陌踩约胺�(wěn)定性。方法:對(duì)10名無脊柱病變的志愿者進(jìn)行脊柱T1～T8節(jié)段CT掃描,在獲得的CT圖像上測(cè)定各節(jié)段的PRU途徑置釘安全角度范圍、椎弓根橫徑、PRU橫徑、椎弓根縱徑、PRU縱徑及PRU重疊縱徑。取4具尸體脊柱標(biāo)本(T1～T8節(jié)段),對(duì)應(yīng)肋骨保留10 cm左右。隨機(jī)于每個(gè)脊柱標(biāo)本的兩側(cè)分別經(jīng)經(jīng)典椎弓根途徑和PRU途徑置入椎弓根螺釘,兩側(cè)螺釘?shù)闹睆郊伴L(zhǎng)度分別為對(duì)應(yīng)的椎弓根橫徑的70%和各自釘?shù)雷铋L(zhǎng)值的70%。應(yīng)用Instron 5569電子萬能試驗(yàn)機(jī)測(cè)定螺釘?shù)目拱纬隽Α＝Y(jié)果:10名志愿者T1～T8經(jīng)PRU途徑置釘?shù)陌踩嵌确秶謩e為19.71°±1.64°、19.42°±1.88°、17.17°±0.67°、17.22°±1.17°、19.36°±1.31°、18.67°±1.58°、18.82°±2.60°、18.72°±1.58°。10名志愿者T1～T8椎弓根橫徑均小于同節(jié)段的PRU橫徑[(8.78±0.05)mm,(18.23±2.46)mm,t=18.192,P=0.013;(7.59±0.08)mm,(16.80±1.31)mm,t=20.175,P=0.002;(6.29±0.07)mm,(15.12±1.22)mm,t=20.271,P=0.004;(5.50±0.05)mm,(14.43±1.00)mm,t=27.403,P=0.004;(5.52±0.06)mm,(14.02±0.85)mm,t=20.312,P=0.001;(5.90±0.06)mm,(14.19±1.12)mm,t=16.772,P=0.047;(6.31±0.07)mm,(14.77±1.31)mm,t=14.229,P=0.017;(6.64±0.03)mm,(15.53±1.90)mm,t=13.000,P=0.048]。10名志愿者T1～T8椎弓根縱徑、PRU縱徑、PRU重疊縱徑三者之間總體比較,差異均有統(tǒng)計(jì)學(xué)意義[(8.04±1.01)mm,(11.05±1.83)mm,(6.37±0.68)mm,F=236.422,P=0.000;(10.72±0.99)mm,(13.09±1.30)mm,(7.46±1.12)mm,F=60.570,P=0.000;(11.34±0.99)mm,(13.45±0.92)mm,(8.99±0.62)mm,F=67.560,P=0.000;(10.67±0.91)mm,(12.49±0.94)mm,(7.94±0.84)mm,F=64.965,P=0.000;(10.34±0.94)mm,(11.96±0.95)mm,(7.96±0.96)mm,F=44.926,P=0.000;(11.33±0.96)mm,(12.36±0.62)mm,(7.72±0.88)mm,F=85.197,P=0.000;(11.30±0.82)mm,(12.16±0.71)mm,(8.34±0.47)mm,F=92.350,P=0.000;(11.39±0.78)mm,(13.71±1.51)mm,(9.34±0.93)mm,F=37.867,P=0.000]。T1～T8椎弓根縱徑和PRU縱徑均大于PRU重疊縱徑(P=0.004,P=0.003,P=0.001,P=0.002,P=0.013,P=0.030,P=0.025,P=0.001; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000),椎弓根縱徑均小于PRU縱徑(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。T1～T8各節(jié)段經(jīng)椎弓根途徑置入螺釘?shù)目拱纬隽笥诮?jīng)PRU途徑[(663.60±22.13)N,(470.33±33.09)N,t=27.876,P=0.000;(702.82±24.23)N,(531.76±13.53)N,t=38.402,P=0.000;(713.58±37.90)N,(544.98±14.22)N,t=37.518,P=0.000;(700.70±35.66)N,(590.80±24.72)N,t=10.512,P=0.000;(805.28±64.67)N,(591.50±62.55)N,t=19.546,P=0.000;(808.68±42.84)N,(629.08±43.09)N,t=19.436,P=0.000;(864.62±35.49)N,(591.60±52.91)N,t=24.350,P=0.000;(909.18±46.05)N,(640.70±21.41)N,t=15.162,P=0.000]。結(jié)論:上中胸椎經(jīng)PRU途徑置入椎弓根螺釘?shù)陌踩詢?yōu)于經(jīng)椎弓根途徑,但置入螺釘?shù)姆�(wěn)定性不及后者。
Abstract:
Objective:To explore the safety and stability of upper-middle thoracic pedicle screw insertion through pedicle rib unit(PRU)approach.Methods:Ten volunteers with no spinal disease received CT scanning at T1-8 vertebral segments,and safe angle range of pedicle screw insertion through PRU approach,transverse diameter of pedicle of vertebral arch,transverse diameter of PRU,longitudinal diameter of pedicle of vertebral arch,longitudinal diameter of PRU and PRU overlapped longitudinal diameter of all segments were measured on the obtained CT images.Four cadaveric T1-8 specimens were selected and 10 cm long ribs were reserved.The pedicle screws were randomly inserted into both sides of each spine specimen through classical pedicle of vertebral arch approach and PRU approach respectively.The diameters of the screws were 70% of transverse diameter of corresponding pedicles of vertebral arch and the lengths of the screws were 70% of the maximal values of corresponding screw path lengths.The pull-out strength of the screws were measured by using instron 5569 electronic universal testing machine.Results:The safe angle ranges of pedicle screw insertion through PRU approach were 19.71+/-1.64,19.42+/-1.88,17.17+/-0.67,17.22+/-1.17,19.36+/-1.31,18.67+/-1.58,18.82+/-2.60,18.72+/-1.58 degrees respectively at T1-8 vertebral segments of 10 volunteers.The transverse diameters of pedicle of vertebral arch were less than the transverse diameter of PRU at T1-8 vertebral segments of the 10 volunteers(8.78+/-0.05 vs 18.23+/-2.46 mm,t=18.192,P=0.013; 7.59+/-0.08 vs 16.80+/-1.31 mm,t=20.175,P=0.002; 6.29+/-0.07 vs 15.12+/-1.22 mm,t=20.271,P=0.004; 5.50+/-0.05 vs 14.43+/-1.00 mm,t=27.403,P=0.004; 5.52+/-0.06 vs 14.02+/-0.85 mm,t=20.312,P=0.001; 5.90+/-0.06 vs 14.19+/-1.12 mm,t=16.772,P=0.047; 6.31+/-0.07 vs 14.77+/-1.31 mm,t=14.229,P=0.017; 6.64+/-0.03 vs 15.53+/-1.90 mm,t=13.000,P=0.048).In general,there was statistical difference between longitudinal diameter of pedicle of vertebral arch,longitudinal diameter of PRU and PRU overlapped longitudinal diameter at T1-8 vertebral segments of the 10 volunteers(8.04+/-1.01,11.05+/-1.83,6.37+/-0.68 mm,F=236.422,P=0.000; 10.72+/-0.99,13.09+/-1.30,7.46+/-1.12 mm,F=60.570,P=0.000; 11.34+/-0.99,13.45+/-0.92,8.99+/-0.62 mm,F=67.560,P=0.000; 10.67+/-0.91,12.49+/-0.94,7.94+/-0.84 mm,F=64.965,P=0.000; 10.34+/-0.94,11.96+/-0.95,7.96+/-0.96 mm,F=44.926,P=0.000; 11.33+/-0.96,12.36+/-0.62,7.72+/-0.88 mm,F=85.197,P=0.000; 11.30+/-0.82,12.16+/-0.71,8.34+/-0.47 mm,F=92.350,P=0.000; 11.39+/-0.78,13.71+/-1.51,9.34+/-0.93 mm,F=37.867,P=0.000).The longitudinal diameter of pedicle of vertebral arch and the longitudinal diameter of PRU were larger than PRU overlapped longitudinal diameter of the 10 volunteers at T1-8 vertebral segments(P=0.004,P=0.003,P=0.001,P=0.002,P=0.013,P=0.030,P=0.025,P=0.001; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000),and the longitudinal diameter of pedicle of vertebral arch was less than longitudinal diameter of PRU(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).The pull-out strengths of the screws inserted through the pedicle of vertebral arch approach were greater than those through PRU approach at T1-8 vertebral segments(663.60+/-22.13 vs 470.33+/-33.09 N,t=27.876,P=0.000; 702.82+/-24.23 vs 531.76+/-13.53 N,t=38.402,P=0.000; 713.58+/-37.90 vs 544.98+/-14.22 N,t=37.518,P=0.000; 700.70+/-35.66 vs 590.80+/-24.72 N,t=10.512,P=0.000; 805.28+/-64.67 vs 591.50+/-62.55 N,t=19.546,P=0.000; 808.68+/-42.84 vs 629.08+/-43.09 N,t=19.436,P=0.000; 864.62+/-35.49 vs 591.60+/-52.91 N,t=24.350,P=0.000; 909.18+/-46.05 vs 640.70+/-21.41 N,t=15.162,P=0.000).Conclusion:PRU approach surpasses pedicle of vertebral arch approach in the safety of upper-middle thoracic pedicle screw insertion,however,the latter surpasses the former in the stability of inserted screws.

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備注/Memo

備注/Memo:
基金項(xiàng)目:全國名老中醫(yī)藥專家傳承工作室建設(shè)項(xiàng)目[國中醫(yī)藥人教發(fā)2014(20)號(hào)]
通訊作者:盛紅楓 E-mail:[email protected]
更新日期/Last Update: 2017-08-07