胸腰椎论文：胸腰椎椎弓根解剖结构的测量与椎弓根钻孔器的研制

胸腰椎：胸腰椎椎弓根解剖结构的测量与椎弓根钻孔器的研制 胸腰椎论文:胸腰椎椎弓根解剖结构的测量与椎弓根钻孔器的研制 【中文摘要】第一部分下胸椎和腰椎椎弓根解剖结构的临床意义利用螺旋CT测量和下胸椎和腰椎椎弓根解剖结构特点,为临床手术操作提供参考。选取6具T9~L5成人脊柱标本,测量数据主要包括椎弓根峡部高和宽,内、外、上、下缘的皮质骨厚度及松质骨的高度和宽度,松质骨所占的比重及椎弓根内倾角和上倾角,椎弓根长度和椎弓根螺钉通道长度。胸腰椎椎弓根峡部高及宽由T9~T12逐渐增大,至L1~L3水平略有减小后至L5增至最大。松质骨高及宽呈相似趋势,其高和宽分别占椎弓根高和宽的69.3%-87.9%和67.9%-79.4%。椎弓根上下缘皮质骨厚度无统计学差异,但均明显厚于内外缘。椎弓根内缘皮质厚度明显厚于外缘,差异有显著性(P<0.001)。椎弓根上倾角由T9~L5逐渐减小,内倾角T12水平最小,L5水平最大。椎弓根长度以L2水平最长,以L5最短。而椎弓根螺钉通道长度以L2水平最长,T11水平最短。胸腰椎椎弓根不同节段的解剖特点存在差异且具有一定的规律性,对其解剖结构的认识有助于提高经椎弓根螺钉植入的准确性和安全性。第二部分新型椎弓根钻孔器的研制和实验研究一种新型椎弓根钻孔器,与常规椎弓根钉道准备的方法相比较,以评估该钻在植入椎弓根螺钉时的安全性和准确性,并测量新钻对椎弓根的穿透力。6具T9~L5成人脊柱标本,108个椎弓根。实验组(左侧,n=54):新型椎弓根钻孔器建立椎弓根螺钉通道后植入螺钉。对照 组(右侧,n=54):应用克氏针钝头建立通道,经扩孔后植入螺钉。直视 下误植螺钉,应用游标卡尺测量螺钉穿破皮质程度。应用新型钻 孔器穿刺新鲜椎弓根标本松质骨和内外侧皮质骨,测量所需的穿透 力。植入108枚螺钉,直视下观察发现有17(15.8%)枚螺钉误植,其中 7枚(6.5%)刺破内侧皮质,10枚(9.3%)刺破外侧皮质。椎弓根钻孔器 组54个螺钉4例位置不良,发生率为7.4%(4/54),而克氏针组54个 螺钉13例位置不良,发生率为24.1%(13/54),应用新钻植入成功率高 于克氏针,差异具有统计学意义(P<0.05)。通过测量穿透内外侧皮质 的平均力值为(165.16?21.76)N和(74.66?15.32)N,而松质骨穿透 力较小,平均为(14.05?2.81 )N,统计学具有显著性差异 (P<0.0001)。体外实验表明:设计的新型椎弓根钻孔器能安全、有效 的建立椎弓根螺钉通道,且能顺利穿透松质骨,而遇到皮质骨则较难 穿破,可以作为传统准备椎弓根螺钉钉道的一种替代方法。 【英文摘要】Part one The clinical significance of anatomic characteristics of lower thoracic and lumbar pedicles[]To measure and analysis the anatomic architecture and the clinical significance of lower thoracic and lumbar pedicles using spiral Computerized Tomography(CT),and to provide references for clinical surgery.[Methods]Six human adult spines(T9~L5) were gathered from preservative cadavers. Spiral CT was used to scan from T9 to L5.The measurement data included pedicle isthmus height and width,the isthmus endsteal width and height,the cortical thickness of the superior,inferior,medial and lateral walls,the proportion of pedicle trabecular core,pedicle transverse angle,pedicle sagittal angle,pedicle length and pedicle chord length.[Result]The pedicle isthmus height and width of thoracolumbar increased gradually from T9 to T12,after a slight decrease at L1 and L2,and the heightest and widthest of pedicle ithsmus were seen in L5.The height and width of cancellous bone showed similar trends. The cancellous core was more than twice as large as the cortical shell, with a range from 69.3% to 87.9% with respect to the pedicle height, and 67.9% to 79.4% with respect to the pedicle width. There was no difference between the cortical thickness of superior and that of inferior,but all were thicker than the medial and lateral wall.The medial wall was thicker than the lateral wall throughout T9~L5,these differences were highly significant(P< 0.001) .The pedicle sagittal angle was decrease gradually T9 to L5.And pedicle transverse angle was seen minimum in T12 and maximum in L5.The longest and shortest of pedicles were seen in L2 and L5 respectively,and the longest and shortest of pedicle chord length were in L2 and T11.[Conclusion]The anatomical characteristics of different segments thoracolumbar pedicles are different but with some regularity. A better understanding of the complicated structure of the pedicle isthmus guarantees safety and accuracy in transpedicular screw procedures.[]To design a pedicle perforator and to evaluate the accuracy and safety of the device in comparison with techniques commonly used for pedicle cannulation in pedicle screw placement,and to measure the penetration strength of pedicle using the device.[Methods]Six human adult spines(T9~L5) were gathered from preservative cadavers,108 pedicles. For each spine specimen,the pedicles of one side(left pedicles,n=54) were cannulated with the new pedicle perforator-pedicle finder, then were placed pedicle screws. For the other side of specimen(right pedicles,n=54),the pedicles were cannulated with conventional placement technique using Kirschner wire.Once cannulated,a pedicle screw was inserted into the pilot hole.By direct observation,the misplacement of screws were recorded and the magnitude of the invasive cortical was measured with a vernier caliper. The penetration strength test of cancellous bone and medial and lateral wall of pedicle using the pedicle perforator was performed.[Result]By direct observation,17 of 108 screws(15.7%) violated the pedicle wall: seven(6.5%) medially and ten(9.3%) laterally.Of the 54 pedicle screws with pedicle perforator,4(7.4%)were classified as perforated pedicle.Of the 54 pedicle screws inserted using Kirschner wire,13(24.1%)were classified as perforated pedicle.The difference in frequency of screw misplacement between the procedure using pedicle perforator and that using Kirschner-wire was statistically significant(P<0.05). The average penetration strengths using the pedicle perforator to penetrate the medial and lateral were (165.16?21.76)N and (74.66?15.32)N respectively,and the penetration strength of cancellous bone was (14.05?2.81)N(P<0.0001).[Conclusion]In vitro study demonstrates that the new pedicle perforator can safely and effectively establish the pedicle screw channel, and also smoothly penetrate the cancellous bone and difficultly perforate the cortical bone.And it may represent an alternative to traditional pedicle cannulation techniques in the thoracolumbar. 【关键词】胸腰椎 椎弓根峡部 解剖结构 脊柱 螺钉 安全性和 准确性 穿透力 【备注】索购全文在线加好友:1.3.9.9.3.8848 同时提供论文写作一对一指导和论文发表委托服务 【英文关键词】Thoracolumbar pedicle Pedicle isthmus Anatomical characteristics Spine Pedicle screw Accuracy and safety Penetration strength 【目录】胸腰椎椎弓根解剖结构的测量与椎弓根钻孔器的研制 中文摘要 5-7 Abstract 7-9 引言 11-13 第一 部分 下胸椎和腰椎椎弓根的解剖学研究及临床意义 13-27 材 料与方法 13-15 结果 15-20 讨论 20-23 结论 23-24 参考文献 24-27 第二部分 新型椎弓根钻孔器的 研制及实验研究 27-41 材料和方法 27-32 结果 32-34 讨论 34-37 结论 37-38 参考文献 38-41 附图 41-44 综述:胸腰椎椎弓根螺钉植入技术的 研究进展 44-57 参考文献 52-57 英文缩写词表 57-58 攻读学位期间公开发表的论文 58-59 致谢 59-61