【摘要】 目的:探讨标准正侧位X线片上T9～L5椎弓根螺钉进钉点及进钉深度的规律。方法:10具T9～L5脊柱标本,解剖出单个椎体。测量分析下列数据:导针沿椎弓根轴线到达椎体前缘皮质下时,标准侧位X线片导针在椎体内深度及标准正位X线片导针与棘突的关系;导针退至椎弓根后端皮质时,时钟法记录标准正位X线片进针点与椎弓根投影的关系。结果:T9～L5导针最大深度为(71.53±5.72)%～(93.28±3.72)%,L1～5无显著性差异(P>0.05),T9、L4～5无显著性差异(P>0.05),T10～11无显著性差异(P>0.05),其它节段椎体间具有显著性差异(P<0.001);正位片上导针不超过棘突影边缘;进钉点左侧位于椎弓根投影9点到10点间,右侧位于2点到3点间,腰椎恰好位于投影之上,而胸椎位于投影内侧约1～2mm。结论:标准侧位片结合标准正位片较好判断导针深度,时钟法可为临床上确定正确的进针点提供一种参考。更多还原

【Abstract】 Objective: To explore the entry point and the length of thoracolumbar pedicle screw on the standard postero-anterior and lateral images of vertebrae. Methods: Ten human samples of cadaveric thoracolumbar spines (T9～L5) were selected and anatomized into single vertebra. Following data were analyzed: the ratio of the length of guide wire in vertebrae on the standard lateral image and the correlation between the wire and the projection of spinous processes on the standard postero-anterior image of vertebrae when the guide wire was consistent with the pedicle axis and reached the anterior cortex of vertebrae; the correlation between the entry point and the pedicle projection on the standard postero-anterior image of vertebrae when the guide wire was located at the pedicle posterior cortex. Results: On the standard lateral image, the length of the guide wire was from (71.53±5.72)% to (93.28 3.72)% among T9~L5. There was no significant difference in L1~5(P>0.05), T9, L4~5(P>0.05), T10,11(P>0.05). There was greatly significant difference among the others (P<0.001). On the standard postero-anterior image of vertebrae, the wire was not beyond the projection of spinous processes. The entry point located at 9 to 10 o’clock of the pedicle projection on the left and at 2 to 3 o’clock on the right, while the point of the low thoracic vertebrae located at about inner 1~2 mm of the projection. Conclusions: The depth of the guide wire can be determined accurately by the standard lateral image and the standard postero-anterior image of vertebrae, while the entry point can be determined accurately by the projection of pedicle on the standard postero-anterior image according to the O’clock method.更多还原