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目的:为经胸椎肋横突结合区椎弓根外螺钉固定手术提供影像解剖学参数。方法:对50个正常成人的T1～10肋横突结合区进行CT扫描,测量肋横突结合区入路的长度、宽度、高度、内倾角度及下倾角度,并与椎弓根入路对比,数据经统计学处理。根据测量结果设置各椎体入路穿钉参数,在3具成人防腐尸体标本T1～10共30个胸椎体上进行模拟手术,穿钉后CT扫描。结果:肋横突结合区入路进钉长度(59.05±0.83)mm、宽度(15.03±0.73)mm、高度(10.36±1.28)mm、内倾角度(34.53±0.21)°及下倾角度(12.95±1.58)°均大于椎弓根入路进钉长度(45.51±0.56)mm、宽度(5.98±0.78)mm、高度(5.35±0.61)mm、内倾角度(12.31±2.05)°及下倾角度(2.85±1.07)°,差异有统计学意义(P<0.05);根据测量结果设置进钉入路参数,30个胸椎体60枚螺钉均位于肋横突结合区,未见穿入椎管、椎间孔和胸腔。结论:胸椎肋横突结合区螺钉内固定,在解剖学上是可行的,尤其对椎弓根发育畸形和狭窄者,具有安全、可靠、容易定位等优点,为胸椎后路螺钉固定的选位提供参考。
Objective: To provide anatomical parameters for pedicle screw fixation of trans-thoracic rib transverse process. Methods: The CT scan of T1 ~ 10 rib transverse junction in 50 normal adults was performed to measure the length, width, height, incline angle and downtilt angle of the transverse approach junction of the rib transverse process. Compared with the pedicle approach Data were statistically processed. According to the measurement results, we set the parameter of each vertebral body penetrating nailing. We simulated the operation on 30 thoracic vertebrae in 3 adult anticorrosive cadaver specimens from T1 to 10, and post-nailing CT scan. RESULTS: The length of the staple inserted into the transverse junction of the transverse process was 59.05 ± 0.83 mm, the width was 15.03 ± 0.73 mm, the height was 10.36 ± 1.28 mm, the incline angle was 34.53 ± 0.21 ° and the incline angle was 12.95 ± 1.58) ° were greater than those of pedicle screw (45.51 ± 0.56) mm, width (5.98 ± 0.78) mm, height (5.35 ± 0.61) mm, incline angle (12.31 ± 2.05) ± 1.07) °, the difference was statistically significant (P <0.05); according to the measurement results set into the nail into the road parameters, 30 thoracic vertebrae 60 screws are located in the rib transverse process, no penetration into the spinal canal, vertebral Between the hole and chest. Conclusion: The internal fixation of the transverse process of the thoracic rib is anatomically feasible, especially for those with deformity and stenosis of pedicle, which is safe, reliable and easy to locate. It is the best choice for posterior thoracic screw fixation for reference.