• 昆明醫(yī)學(xué)院第二附屬醫(yī)院骨科（昆明，650101）;

【摘 要】 目的  探討基于胸椎椎弓根髓腔內(nèi)徑CT分型在對嚴(yán)重僵硬性脊柱畸形行經(jīng)后路全脊椎切除術(shù)（posterior vertebral column resection，PVCR）矯形徒手植釘中的臨床意義。 方法 2004年10月－2010年7月對56例嚴(yán)重僵硬性脊柱畸形患者一期行PVCR矯形，T2～12共植入1 098枚椎弓根螺釘。于CT片測量胸椎椎弓根髓腔內(nèi)徑，并劃分為4個(gè)區(qū)間：區(qū)間1（0～1.0 mm），區(qū)間2（1.1～2.0 mm），區(qū)間3（2.1～3.0 mm），區(qū)間4（ gt; 3.1 mm）；對各區(qū)間椎弓根螺釘植釘成功率進(jìn)行統(tǒng)計(jì)學(xué)分析。根據(jù)結(jié)果將無統(tǒng)計(jì)學(xué)意義的區(qū)間合并，再次行統(tǒng)計(jì)學(xué)分析。根據(jù)Lenke的椎弓根形態(tài)學(xué)分型，行各型植釘成功率統(tǒng)計(jì)學(xué)分析。 結(jié)果  1 098枚胸椎椎弓根螺釘中，826枚（75.23%）植釘成功。根據(jù)髓腔內(nèi)徑分區(qū)，除區(qū)間3與區(qū)間4椎弓根植釘成功率比較差異無統(tǒng)計(jì)學(xué)意義（χ2=2.540，P=0.111）外，其余各組間比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.008）。區(qū)間3、4合并后，區(qū)間1、2、3植釘成功率分別為35.05%、65.34%、88.32%，兩兩比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.017）。根據(jù)Lenke的椎弓根形態(tài)學(xué)分型，A、B、C、D型植釘成功率分別為82.31%、83.40%、80.00%、30.28%，D型植釘成功率顯著低于其余各型（P  lt; 0.008），其余各型間差異均無統(tǒng)計(jì)學(xué)意義（P  gt; 0.008）?；谛刈底倒枨粌?nèi)徑CT分型標(biāo)準(zhǔn)，Ⅰ型椎弓根占總數(shù)的17.67%，凹、凸側(cè)椎弓根分別為24.59%、10.75%；Ⅱa型占總數(shù)的16.03%，凹、凸側(cè)分別為21.13%、10.93%；Ⅱb型占總數(shù)的66.30%，凹、凸側(cè)分別為54.28%、78.32%。各型凹、凸側(cè)分布比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.001）。 結(jié)論 基于胸椎椎弓根髓腔內(nèi)徑提出了量化分型標(biāo)準(zhǔn)，Ⅰ型為無髓腔型，椎弓根內(nèi)徑0～1.0 mm；Ⅱ型為有髓腔型，其中Ⅱa型椎弓根內(nèi)徑為1.1～2.0 mm，Ⅱb型 gt;2.1 mm。該分型標(biāo)準(zhǔn)可在行PVCR時(shí)指導(dǎo)徒手植入胸椎椎弓根螺釘，但其有效性需進(jìn)一步臨床觀察驗(yàn)證。

引用本文： 張穎,解京明,王迎松,畢尼,趙智,李韜. 胸椎椎弓根髓腔內(nèi)徑CT分型在嚴(yán)重僵硬性脊柱畸形矯形中的臨床意義. 中國修復(fù)重建外科雜志, 2012, 26(3): 257-260. doi: 復(fù)制

1. Kyoto: the 45th Annual Meeting of the Scoliosis Research Society, 2010.
2. Xie Jingminig, Wang Yingsong, Zhang Ying, et al. Posterior vertebral column resection for correction of severe rigid spinal deformity (abstract).
3. Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
4. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
5. Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976), 1997, 22(19): 2239-2245.
6. Lee CS, Kim MJ, Ahn YJ, et al. Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech, 2007, 20(1): 66-71.
7. Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
8. Zindrick MR, Knight GW, Sartori MJ, et al. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976), 2000, 25(21): 2726-2735.
9. Liljenqvist UR, Allkemper T, Hackenberg L, et al. Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic. J Bone Joint Surg (Am), 2002, 84-A(3): 359-368.
10. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
11. Suk SI, Kim WJ, Lee SM, et al. Thoracic pedicle screw in spinal deformities: are they really safe. Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
12. Parent S, Labelle H, Skalli W, et al. Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine (Phila Pa 1976), 2004, 29(3): 239-248.
13. Lenke LG, Watanabe K, Matsumoto M, et al. A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine (Phila Pa 1976), 2010, 35(20):1836-1842.
14. Ferrick MR, Kowalki JM, Simmons ED. Reliability of roentgenogram evaluation of pedicle screw position. Spine (Phila Pa 1976), 1997, 22(11): 1249-1252.
15. Fu TS, Wong CB, Liang YC, et al. Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop, 2007, 32(4): 517-521.
16. Cincotti G, Gumina S, Ripanni P, et al. Pedicle instrumentation in the thoracic spine. A mophemetric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
17. Ebraheim NA, Jabaly G, Xu R, et al. Anatomic relations of the thoracic pedicle to adjacent neural structures. Spine (Phila Pa 1976), 2007, 22(14): 1553-1557.
18. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
19. Banta CJ 2nd, King AG, Dabezies EJ, et al. Measurement of effective pedicle diameter in the human spine. Orthopedics, 1989, 12(7): 939-942.
20. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphemetric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166.
21. Defino HL, Vendrame JR. Role of cortical and cancellous bone of the vertebral pedicle in implant fixation. Eur Spine J, 2001, 10(4): 325-333.
  1. 1. Kyoto: the 45th Annual Meeting of the Scoliosis Research Society, 2010.
  2. 2. Xie Jingminig, Wang Yingsong, Zhang Ying, et al. Posterior vertebral column resection for correction of severe rigid spinal deformity (abstract).
  3. 3. Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
  4. 4. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
  5. 5. Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976), 1997, 22(19): 2239-2245.
  6. 6. Lee CS, Kim MJ, Ahn YJ, et al. Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech, 2007, 20(1): 66-71.
  7. 7. Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
  8. 8. Zindrick MR, Knight GW, Sartori MJ, et al. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976), 2000, 25(21): 2726-2735.
  9. 9. Liljenqvist UR, Allkemper T, Hackenberg L, et al. Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic. J Bone Joint Surg (Am), 2002, 84-A(3): 359-368.
  10. 10. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
  11. 11. Suk SI, Kim WJ, Lee SM, et al. Thoracic pedicle screw in spinal deformities: are they really safe. Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
  12. 12. Parent S, Labelle H, Skalli W, et al. Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine (Phila Pa 1976), 2004, 29(3): 239-248.
  13. 13. Lenke LG, Watanabe K, Matsumoto M, et al. A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine (Phila Pa 1976), 2010, 35(20):1836-1842.
  14. 14. Ferrick MR, Kowalki JM, Simmons ED. Reliability of roentgenogram evaluation of pedicle screw position. Spine (Phila Pa 1976), 1997, 22(11): 1249-1252.
  15. 15. Fu TS, Wong CB, Liang YC, et al. Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop, 2007, 32(4): 517-521.
  16. 16. Cincotti G, Gumina S, Ripanni P, et al. Pedicle instrumentation in the thoracic spine. A mophemetric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
  17. 17. Ebraheim NA, Jabaly G, Xu R, et al. Anatomic relations of the thoracic pedicle to adjacent neural structures. Spine (Phila Pa 1976), 2007, 22(14): 1553-1557.
  18. 18. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
  19. 19. Banta CJ 2nd, King AG, Dabezies EJ, et al. Measurement of effective pedicle diameter in the human spine. Orthopedics, 1989, 12(7): 939-942.
  20. 20. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphemetric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166.
  21. 21. Defino HL, Vendrame JR. Role of cortical and cancellous bone of the vertebral pedicle in implant fixation. Eur Spine J, 2001, 10(4): 325-333.