上胸椎椎弓根螺钉钉道与椎前重要结构解剖位置的CT评价.doc

上胸椎椎弓根螺钉钉道与椎前重要结构解剖位置的CT评价邢文华1，郝利霞2，霍洪军1，杨学军11内蒙古医科大学第二附属医院脊柱外科，内蒙古自治区呼和浩特市 010030；2内蒙古医科大学附属医院康复科，内蒙古自治区呼和浩特市 010050Screw path of pedicle of upper thoracic spine and anatomical positions of prevertebral key structures: computed tomography evaluationXing Wen-hua1, Hao Li-xia2, Huo Hong-jun1, Yang Xue-jun11Department of Spine Surgery, Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China; 2 Department of Rehabilitation, Hospital Affiliated to Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China摘要 背景：上胸椎周围结构复杂，椎弓根横径相对较小，椎体前方存在重要组织脏器，螺钉偏离轴线或螺钉过长，置钉的安全性和有效性得不到保障，有必要对其周围重要结构做一了解。目的：分析上胸椎椎弓根螺钉轴线与椎体前重要毗邻结构的解剖位置关系。方法：对30例健康成人志愿者进行T1-T4平行椎弓根轴线CT扫描，观察椎弓根螺钉沿椎弓根轴线置入时椎体前方食管、气管、主动脉弓、颈动脉、椎动脉等结构的位置，测量每一椎体两侧椎弓根轴线与这些结构的最短距离。采用配对t检验进行分析。结果与结论：共240个测量参数被分析，T 1-3左侧椎弓根轴线与食管距离小，T2左侧椎弓根最小；T 2-4右侧椎弓根轴线与气管距离小；T3，T4右侧椎弓根轴线与右主支气管距离小；颈动脉和椎动脉无损伤的危险性。62%的患者主动脉弓在T4平面，且无损伤危险性。提示左侧椎弓根螺钉易损伤食管，右侧椎弓根易损伤气管，颈动脉、椎动脉和主动脉弓不易损伤。上胸椎椎弓根螺钉置入前仔细分析CT数据可以确定易损伤结构的解剖位置。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：窗体顶端关键词 ： 植入物； 脊柱植入物； 胸椎； 椎弓根螺钉； 解剖学； 食管； 气管； 主动脉弓； 颈动脉； 椎动脉； Abstract： BACKGROUND: The structure surrounding upper thoracic spine is complicated. Transverse diameter of pedicle was relatively small. There were important organs in front of the vertebral body. Screws deviated from axis or screws were too long. The safety and effectiveness of screw implantation were not implemented. It is necessary to understand the key structure of surroundings. OBJECTIVE: To analyze the relationship of anatomic position between the axis of screw of pedicle of upper thoracic spine and key adjacent structure of the vertebral body. METHODS: A total of 30 healthy adult volunteers received T1-T4 pedicle axis parallel to CT scans. The positions of esophagus, trachea position, aortic arch, carotid and vertebral arteries were observed when the pedicle screw was implanted along the pedicle axis. The shortest distance on both sides of a vertebral pedicle axis from these structures was measured. Paired t-test was utilized for analysis.RESULTS AND CONCLUSION: 240 measurement parameters were analyzed. The distance from the left pedicle axis on T 1-3 to esophagus was small, and the left pedicle on T2 was minimal. The distance from the right pedicle axis on T 2-4 to trachea was small. The distance from right pedicle axis on T3, T4 to right main bronchus was small. Carotid and vertebral artery did not show the risk of injury. 62% of the patients were in the aortic arch on T4 plane, and no risk of damage was found. These results indicated that the left pedicle screws were easy to damage the esophagus, and the right pedicle screw was easy to damage trachea. Carotid artery, vertebral artery and aortic arch were not easy to be damaged. The anatomic position of easily damaged structure could be identified by careful analysis of CT data before screw implantation in the pedicle of upper thoracic spine.中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：Key words： internal fixators; thoracic vertebrae; anatomy; esophagus; trachea; 窗体底端 中图分类号:R318 作者简介: 邢文华，男，1977年生，内蒙古自治区呼和浩特市人，汉族，2011年解放军第二军医大学毕业，博士，副主任医师，主要从事脊柱外科方面的研究。引用本文: 邢文华,郝利霞,霍洪军等. 上胸椎椎弓根螺钉钉道与椎前重要结构解剖位置的CT评价J. 中国组织工程研究, 2014, 18(26): 4190-4194. Xing Wen-hua,Hao Li-xia,Huo Hong-jun et al. Screw path of pedicle of upper t