华西医学

华西医学

骶 1 椎采用三皮质固定技术置钉时损伤骶正中动脉风险的研究

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目的探讨骶 1 椎弓根螺钉三皮质固定技术置钉时,螺钉出钉点与骶正中动脉的相距距离和安全性。方法2018 年 3 月—6 月随机选取自贡市第四人民医院 98 例含血管造影的成人骨盆薄层 CT 扫描数据。分别测量骶正中动脉在骶 1 上终板平面距椎体前缘的距离a 和距椎体中线的距离 b,进针点定位于关节突的外侧缘与下缘的交点。采用临床常用内倾角度 10、15、20、25° 置钉,测量其螺钉出钉点与骶正中动脉的距离 d结果骶正中动脉在骶 1 上终板平面通常位于骶 1 椎体的左侧;49 例男性和 49 例女性骶正中动脉距椎体前缘的距离 a 分别为(5.40±2.95)、(4.43±2.32)mm,男女差异无统计学意义(t=1.818,P=0.72);45 例男性和 48 例女性骶正中动脉距椎体中线的距离 b 分别为(12.07±5.42)、(14.12±4.88)mm,男女差异无统计学意义(t=–1.914,P=0.59)。采用内倾角 10、15、20、25° 置钉时出钉点与骶正中动脉的距离 d 分别为(12.67±6.00)、(9.40±5.17)、(7.50±3.76)、(8.10±3.64)mm,内倾角 10° 与 15、20、25° 置钉时距骶正中动脉的距离比较差异均有统计学意义(t=16.828、11.609、6.073,P<0.008 3),15° 与 20° 置钉比较差异有统计学意义(t=6.254,P<0.008 3),15° 与 25°、20° 与 25° 置钉比较差异无统计学意义(t=2.034、–1.723,P>0.05)。结论通过分析骶正中动脉与在骶 1 椎上终板平面与椎体的解剖位置关系,采用 Lenham 方法置钉时在增加螺钉生物力学稳定性的同时,骶正中动脉损伤的风险较小。

ObjectiveTo investigate the distance between the screw-out point and the middle sacral artery, and evaluate the safety when the S1 pedicle screw placed by the three cortical fixation techniques.MethodsFrom March to June 2018, randomized CT scan data of 98 adult pelvic angiography were selected to measure the distance from the middle sacral artery to the anterior edge of the vertebral body (a) and the distance from the middle sacral artery to the midline of the vertebral body (b). S1 screw entry point was set as the intersection of lines where extension of S1 facet joint inferior margin and lateral margin cross over. Introversion angles of 10, 15, 20, and 25° were used; the distance between the screw insertion point and the middle sacral artery (d) was measured.ResultsThe middle sacral artery was usually located on the left side of the upper endplate plane of S1. The distance a was (5.40±2.95) mm in 49 males and (4.43±2.32) mm in 49 females, and the difference between the males and females was not statistically significant (t=1.818, P=0.72). The distance b was (12.07±5.42) mm in 45 males and (14.12±4.88) mm in 48 females, and the difference between the males and females was not statistically significant (t=–1.914, P=0.59). The distance d was (12.67±6.00), (9.40±5.17), (7.50±3.76), and (8.10±3.64) mm when the nail was placed at a common internal inclination of 10, 15, 20, and 25°. The differences in the distance d at a common internal inclination of 10° vs. 15°, 10° vs. 20°, 10° vs. 25°, and 15° vs. 20° were all statistically significant (t=16.828, 11.609, 6.073, 6.254; P<0.008 3); there was no statistically significant difference in that at 15°vs. 25°, or 20° vs. 25° (t=2.034, –1.723; P>0.05).ConclusionBy analyzing the relationship between the middle sacral artery and the upper endplate plane of the S1 vertebra, the risk of middle artery injury is small while the biomechanical stability of the screw is increased when using the Lenham method.

关键词: 骶椎; 骶正中动脉; 椎弓根螺钉; 解剖

Key words: Sacrum; Middle sacral artery; Pedicle screw; Anatomy

引用本文: 万盛钰, 林旭, 王翔宇, 曾俊, 钟泽莅, 吴超, 谭伦. 骶 1 椎采用三皮质固定技术置钉时损伤骶正中动脉风险的研究. 华西医学, 2018, 33(9): 1106-1109. doi: 10.7507/1002-0179.201808051 复制

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