横突根部入路经皮椎弓根螺钉的解剖基础研究

doi:10.13418/j.issn.1001-165x.2024.3.02

Abstract

Abstract: Objective To study the anatomical basis of the percutaneous pedicle screw fixation technique in transverse process root approach and analyze the feasibility of the screw placement method. Methods In this study, 3D CT reconstruction images of 100 adult lumbar spine from L1 to L5 were analyzed by using the PACS system. The imaging anatomical parameters of the screw cross section, including the insertion angle, width of the pedicle, length of the ideal screw tract and length of the ideal screw tract within the pedicle were measured. Results There was no statistical difference between the left and right sides of the same vertebral level (P>0.05). Additionally, there was no significant difference in angle measurements between different genders (P>0.05). However, there were significant differences in most length indicators between genders (P<0.05), with males having larger measurements compared with females. The minimum inner inclination angles from L1 to L5 were as follows: 15.40°, 16.63°, 14.74°, 11.82°, and 6.82°, respectively. The maximum inner inclination angles were: 36.22°, 38.86°, 42.99°, 49.05°, and 54.70°, respectively. The ideal inclination angles were: 23.67°, 24.30°, 25.08°, 27.10°, and 29.96°, respectively, exceeded the internal inclination angle of the traditional insertion point and fell within a safe range of 20.83° to 47.88°. In the cross-section where the screw placed, the average pedicle width from L1 to L5 in males was: 6.82, 6.96, 8.38, 10.31 and 13.65 mm, while in females it was: 5.39, 5.78, 7.24, 9.09 and 13.21 mm. The length of the ideal screw tract in males was: 54.90, 55.19, 55.75, 54.87 and 56.27 mm, whereas in females it was: 51.04, 51.31, 52.68, 52.11 and 54.71 mm. The length of the ideal screw tract within the pedicle in males was: 20.85, 19.87, 18.41 mm, 15.87 and 15.02 mm, while in females it was: 20.18, 19.02, 17.00, 15.19 and 15.05 mm. Conclusions The imaging results indicate that the transverse process root approach at a specific anatomical location is a safe and reliable insertion point for pedicle screws. This finding provides new reference for selecting the appropriate insertion point of pedicle screws in percutaneous pedicle screw techniques.

Key words: , Lumbar vertebra, , , Insertion point, , , Pedicle screw, , , , Imaging anatomy

CLC Number:

R323.3

Sun Ke, Zhou Guangwen, Jiang Zhiye, Wang Honggang. Basic anatomical study of percutaneous pedicle screws in transverse process root approach[J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 246-250.

References

[1] Momin AA, Steinmetz MP. Evolution of Minimally Invasive Lumbar Spine Surgery[J]. World Neurosurg, 2020, 140:622-626. DOI: 10.1016/j.wneu.2020.05.071.
[2] Rocca GL, Mazzucchi E, Pignotti F, et al. Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis[J]. Journal of orthopaedics and traumatology, 2022, 23(1):44. DOI: 10.1186/s10195-022-00661-8.
[3] D'Antoni, Anthony, V. Gray's Anatomy: The Anatomical Basis of Clinical Practice 41st edition [M]. Singapore: Elsevier (Singapore). 2016: 755~756. DOI: 10.1016/j.jss.2009.01.035.
[4] Tian F, Tu LY, Gu WF, et al. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis [J]. Medicine (Baltimore). 2018, 97(41):e12535. DOI: 10.1097/MD.0000000000012535.
[5] 余铖灏, 成伟益, 刘盾, 等. 经皮与开放椎弓根螺钉内固定术治疗胸腰椎骨折疗效的Meta分析[J]. 创伤外科杂志, 2021, 23(8):609-620. DOI: 10.3969/j.issn.1009-4237.2021.08.011.
[6] 陈啸. 经皮椎弓根螺钉内固定术治疗胸腰椎骨折置钉准确性与椎弓根参数间关系的临床研究[D]. 安徽医科大学, 2021. DOI: 10.26921/d.cnki.ganyu.2020.000503
[7] Nakahara M, Yasuhara T, Inoue T, et al. Accuracy of percutaneous pedicle screw insertion technique with conventional dual fluoroscopy units and a retrospective comparative study based on surgeon experience[J]. Global Spine J, 2016,6(4):322-328. DOI: 10.1055/s-0035-1563405.
[8] 林书, 胡豇, 万仑, 等. “天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价[J]. 中国修复重建外科杂志, 2021, 35(7):813-817. DOI: 10.3969/j.issn.1004-406X.2020.12.09.
[9] 肖宇, 龙浩, 何祖波, 等. 骨科机器人辅助下行经皮内固定术治疗胸腰椎骨折的置钉准确度及学习曲线分析[J]. 中国脊柱脊髓杂志, 2020, 30(12):1111-1117. DOI: 10.3969/j.issn.1004-406X.2020.12.09.
[10]Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating[J]. Clin Orthop Relat Res, 1986, 203:7-17. DOI: 10.1097/00003086-198602000-00006.
[11]Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation[J]. Clin Orthop Relat Res, 1984, 189:125-141. DOI: 10.1097/00003086-198410000-00014.
[12]Anderson LD. Manual of internal fixation techniques recommanded by the AO ASIF group. 3st edition[M]. Springer-verleg Berlin Heidelberg, 1991: 666. DOI: 10.2106/00004623-199274020-00028.
[13]侯树勋, 史亚民. 国人下胸椎及腰椎椎弓根形态学特点及其临床意义[J]. 中华骨科杂志, 1994, 14(4):222-225. DOI: 10.1007/BF020 06258.
[14]杜心如, 赵玲秀, 张一模, 等. 腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究[J]. 中国临床解剖学杂志, 2002, 20(2):86-88. DOI: 10.3969/j.issn.1001-165X.2002.02.002.
[15]单云官, 李俊祯, 杨少华, 等. 椎弓根形态学观测及其临床意义[J]. 中国临床解剖学杂志, 1988, 6(4):219-221. DOI: 10.13418/j.issn.1001-165x1988.04.017.
[16]杜心如, 赵玲秀, 张一模, 等. 腰椎上关节突关节面后缘与椎弓根中心关系的解剖学观察及其临床意义[J]. 中国矫形外科杂志, 2000, 7(4):57-59.
[17]杜心如, 赵玲秀, 张一模, 等. 腰椎横突平分线与椎弓根侧方平分线关系的解剖学观测及其临床意义[J]. 中国临床解剖学杂志, 2000, 18(4):317-318. DOI: 10.3969/j.issn.1001-165X.2000.04.011
[18]吴龙, 谢成龙, 林仲可. 椎弓根螺钉设计与其生物力学稳定性的研究进展[J]. 脊柱外科杂志, 2019, 17(6):431-435. DOI:10.3969/j.issn. 1672-2957.2019.06.013.
[19]李严兵, 王爱平, 彭田红, 等. 腰椎椎弓根通道不同外偏角方向变化规律的数字解剖学研究[J]. 中国临床解剖学志, 2007, 25(2):113-117. DOI: 10.3969/j.issn.1001-165X.2007.02.001.
[20]Yson SC, Sembrano JN, Sanders PC, et al. Comparison of cranial facet joint violation rates between open and percutaneous pedicle screw placement using intraoperative 3-D CT (O-arm) computer navigation[J]. Spine. 2013; 38(4):E251-E258. DOI: 10.1097/BRS.0b013e31827ecbf1.

Basic anatomical study of percutaneous pedicle screws in transverse process root approach

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Li Haiyan, Liu Yingdong, Song Dongshuai, Yang Zhipeng, Du Xinru. Morphological observation of the communicating branches between accessory nerve, vagus nerve and cervical nerve roots and its clinical significance [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 241-245.
[2]	Lai Wenhua, Mao Longkun, Wang Shiyu, Li Yixuan, Liu Ruiping, Xu Dazheng, Li Mingzhe, Zhou Lihua. Clinical application of celiac trunk typing variants in adults of South China [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 259-264.
[3]	Li Yunlun, Xu Yizhou, Cai Jiale, Xu Shuyi, Zhang Jiaqi, Fu Lanya, Ma Xinrui, He Ye, Wang Xianghai, Guo Jiasong. Clodronate liposome alleviates functional regeneration after peripheral nerve injury via depleting macrophages [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 265-269.
[4]	Que Songnian, Tu Jingdian, Han Shangfeng, Xiong Hang, Song Haiwang, Huang Tao. Effects of Angelica Sinensis Polysaccharide on modulating the gut microbiome in mice subjected to cerebral ischemia-reperfusion injury [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 270-277.
[5]	Yang Lifang, Yu Chunze, Zhang Xianjun, Wu Chunyun, Yu Jianyun, Yang Li. Inhibition effects of cannabidiol on inflammatory response following multiple cerebral concussions in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 278-283.
[6]	Jing Xing, Shi Jinxing, Xu Dan, Zhuang Yuehong, Xie Yun, Wang Hai. Fasudil promotes axon and myelin regeneration and functional recovery after sciatic nerve injury in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 284-292.
[7]	Zhang Bihuan, Cai Xingbo, Wang Bin, Zhang Yue, Xu Yongqing. Establishment and biomechanical analysis of finite element model after partial replacement prosthesis of titanium alloy scaphoid with personalized 3D printing [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 293-303.
[8]	Qi Baochuang, Cai Xingbo, Song Muguo, Meng Chen, Luo Huan, Li Chuan, Xu Yongqing. Clinical efficacy of four-corner arthrodesis concentrator of nickel-titanium memory alloy for carpal collapse: 9-10 years of follow-up [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 304-309.
[9]	Liu Weixiang, Wu Yupeng, Xia Chao, Gong Yonghao, Gao Yiqiang, Yao Nvzhao. Short-term clinical efficacy of unilateral piportal endoscopic technique in the treatment of adjacent segment disease after posterior lumbar interbody fusion [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 310-315.
[10]	Sun Shengxuan, Xie Ye, Shen Guangsi, Zhou Haibin. Clinical effect of “Chinese way” for arthroscopic treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 316-321.
[11]	Zou Yang, Liu Jialong, Jin Yiyi, Li Ninglei, Sun Jingbo, Liu Xiaolong. Application of the three-step method of full laryngeal recurrent nerve visualization in laparoscopic thyroidectomy via anterior chest approach [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 322-325.
[12]	Hu Hao, Zhou Lihua, Lv Guoyi. Comparative analysis of CT 3D reconstruction of chondroblastoma and primary aneurysmal bone cyst [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 326-330.
[13]	Wang Xia, Li Jiayi, Lu Huifen, Cui Haiyan. Effect of pirfenidone on pulmonary interstitial fibrosis after COVID-19 in 2 cases [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 331-335.
[14]	Yan Zi, Li Shiyu, Wang Yilin, Wu Yaobin, Li Yanbing, Huang Wenhua. Research progress of 3D-printed articular cartilage scaffolds [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 341-346.
[15]	Lou Yuanda, Yuan Shuai, Lin Rong, Yao Liwei, Mao Haijiao. Anatomical research progress of posterior tibial tendon [J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 347-349.