中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (21): 3321-3328.doi: 10.3969/j.issn.2095-4344.2652

• 脊柱植入物 spinal implant • 上一篇    下一篇

12-15岁青少年腰椎椎弓根螺钉置入最佳选择的形态学分析

许阳阳1，张  凯2，李志军3，张云凤4，苏宝科1，王  星3，王利东5，王一丹1，和雨洁3，李  琨3，王海燕3，李筱贺3   

  1. 1内蒙古医科大学研究生学院，内蒙古自治区呼和浩特市  010110；2兰察布市第二医院骨科，内蒙古自治区兰察布市  012000；3内蒙古医科大学基础医学院解剖教研室，内蒙古自治区呼和浩特市  010110；4内蒙古医科大学第二附属医院影像科，内蒙古自治区呼和浩特市   010000；5内蒙古国际蒙医医院影像科，内蒙古自治区呼和浩特市  010010
  • 收稿日期:2019-10-21 修回日期:2019-10-25 接受日期:2019-11-29 出版日期:2020-07-28 发布日期:2020-04-16
  • 通讯作者: 王海燕，硕士，副教授，硕士生导师，内蒙古医科大学基础医学院解剖教研室，内蒙古自治区呼和浩特市 010110 李筱贺，博士，教授，硕士生导师，内蒙古医科大学基础医学院解剖教研室，内蒙古自治区呼和浩特市 010110
  • 作者简介:许阳阳，男，1991年生，山西省长治市人，汉族，内蒙古医科大学在读硕士，主要从事数字医学方面的研究。 并列第一作者：张凯，男，1977年生，重庆医科大学在读博士，主治医师，主要从事脊柱外科方面的研究。
  • 基金资助:
    国家自然科学基金(81460330)；国家自然科学基金(81560348，81860383)；内蒙古教育厅青年科技英才项目(njyt-15-b05)；内蒙自治区科技计划项目(2016)；内蒙古自治区科技创新引导项目(2017)；内蒙古自治区自然科学基金(2016ms08131)；内蒙古人社厅归国留学人员基金(TKD2017KJBW012)；内蒙古医科大学科技百万计划基金项目(YKD2017KJBW012)

Morphological analysis of optimal selection of lumbar pedicle screws in adolescents aged 12-15 years

Xu Yangyang1, Zhang Kai2, Li Zhijun3, Zhang Yunfeng4, Su Baoke1, Wang Xing3, Wang Lidong5, Wang Yidan1, He Yujie3, Li Kun3, Wang Haiyan3, Li Xiaohe3   

  1. 1Graduate School of Inner Mongolia Medical University; 2Department of Orthopedics, Ulanqab Second Hospital; 3Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University; 4Department of Radiology, the Second Affiliated Hospital of Inner Mongolia Medical University; 5Deoartment of Radiology, Inner Mongolia International Mongolian Hospital
  • Received:2019-10-21 Revised:2019-10-25 Accepted:2019-11-29 Online:2020-07-28 Published:2020-04-16
  • Contact: Wang Haiyan, Master, Associate professor, Master’s supervisor, Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China Li Xiaohe, MD, Professor, Master’s supervisor, Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • About author:Xu Yangyang, Master candidate, Graduate School of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China Zhang Kai, Doctoral candidate, Attending physician, Department of Orthopedics, Ulanqab Second Hospital, Ulanqab 012000, Inner Mongolia Autonomous Region, China Xu Yangyang and Zhang Kai contributed equally to this work.
  • Supported by:
    the National Natural Science Foundation of China, No. 81460330, 81560348, and 81860383; the Youth Science and Technology Talent Project of Inner Mongolia Education Department, No. njyt-15-b05; Science and Technology Program of Inner Mongolia Autonomous Region, No. 2016; the Science and Technology Innovation Guide Project of Inner Mongolia Autonomous Region, No. 2017; the Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2016ms08131; the Returned Scholar Foundation of Human Resources and Social Security Department of Inner Mongolia Autonomous Region, No. TKD2017KJBW012; the Science and Technology Million Program of Inner Mongolia Medical University, No. YKD2017KJBW012

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摘要：

文题释义：

椎弓根螺钉：椎弓根置钉是目前脊柱内固定的常用方法，椎弓根形态学参数决定置钉成功率，对于发育中的青少年脊柱疾患，椎弓根螺钉同样发挥重大作用。 

三维重建测量：利用三维重建软件对人体组织结构进行3D重建，可清晰完整、更加直观地表现人体组织特点，得到的测量数据更准确，可以更好的服务于临床。

背景：关于成人胸腰段椎弓根形态的研究已经发表了大量文献，但对青少年椎弓根形态的了解较少，尤其是在亚洲人群中。青少年脊柱疾患日益增多且精确的形态学研究较少。

目的：研究内蒙古地区12-15岁青少年腰椎的解剖结构，为椎弓根螺钉置入提供详细资料，确定安全合适的螺钉大小，并为螺钉尺寸设计提供数据参考。

方法：收集内蒙古地区65例12-15岁青少年正常胸腰CT资料，根据年龄分2组，12-13岁31例，14-15岁34例。将连续扫描的胸腰椎断层影像原始数据以DICOM格式导入Mimics 21.0分析与测量，指标包括椎弓根宽、椎弓根高、椎管横径、椎管纵径、椎弓根长、椎弓根外偏角、椎弓根最大外偏角、椎弓根头倾角及椎弓根面积。

结果与结论：①2组L1-L4 椎弓根宽小于椎弓根高，L5椎弓根宽与椎弓根高相似，椎弓根宽决定螺钉直径，男性大于女性；②12-13岁，螺钉长L1-L5均为40-45 mm；14-15岁，螺钉长L1-L4为40-45 mm，L5为45-50 mm；③2组规律相同，椎管横径均大于椎管纵径，椎管横径、椎管纵径之间差异有显著性意义(P < 0.05)，男女之间差异无显著性意义；④椎弓根外偏角：12-13岁L1-L2变化不大，L2-L5逐渐增大；14-15岁L1-L5逐渐增大，2组均男性大于女性；⑤椎弓根最大外偏角：2组规律相同，L1-L5逐渐增大，随年龄增长而减小，左右侧与性别间差异均无显著性意义，不同年龄间差异有显著性意义(P < 0.05)；⑥椎弓根头倾角： 12-13岁为3°-8°，14-15岁为0°-5°；随年龄增长而减小，L3-L4男女之间差异有显著性意义(P < 0.05)；⑦椎弓根面积：2组规律相同，L1-L5逐渐增大，L4-L5有一个明显的变化趋势；⑧根据椎弓根参数分析可得出正常青少年腰椎各节段置入螺钉的适合尺寸，帮助临床医师掌握腰椎解剖结构，提高置钉准确性。

ORCID: 0000-0001-5877-8358(许阳阳)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词:

青少年, 腰椎, 椎弓根螺钉, 形态特征, 三维重建测量, 国家自然科学基金


Abstract:

BACKGROUND: A large amount of literature has been published on the vertebral pedicle morphology at thoracolumbar segments in adults, but little is known about the morphology of pedicles in adolescents, especially in Asian populations. Adolescent spine disorders are increasing and there are few precise morphological studies.

OBJECTIVE: To investigate the anatomy of lumbar vertebrae of adolescents aged 12-15 years in Inner Mongolia, provide detailed information for pedicle screw placement, determine the safe and appropriate screw size, and provide data reference for screw size design.

METHODS: The normal chest and lumbar CT data of 65 adolescents aged 12-15 years in Inner Mongolia were collected and divided into two groups, 31 cases of 12-13 years old, and 34 cases of 14-15 years old. The raw data of the thoracic and lumbar vertebrae images scanned continuously were imported into Mimics 21.0 for analysis and measurement in DICOM format. Pedicle width, pedicle height, transverse diameter, longitudinal diameter, pedicle length, pedicle outer declination, pedicle maximum external angle, pedicle head inclination, and pedicle area were measured.

RESULTS AND CONCLUSION: (1) The L1-L4 pedicle width in the two groups was less than pedicle height, and pedicle width and pedicle height at L5 were similar. The pedicle width determined the screw diameter, which was larger in males than in females. (2) In 12-13 years old, the screw length at L1-L5 was between 40-45 mm. In 14-15 years old, the screw length was between 40-45 mm at L1-L4, and 45-50 mm at L5. (3) The laws of the two groups were the same. The transverse diameter of spinal canal was significantly larger than longitudinal diameter of spinal canal (P < 0.05), and there was no significant difference between men and women. (4) The transverse pedicle angle: In 12-13 years old, L1-L2 had small change, L2-L5 gradually increased; in 14-15 years old, L1-L5 gradually increased; it is larger in males than in females in both groups. (5) Maximum transverse pedicle angle: The two groups had the same law. L1-L5 gradually increased, and decreased with age. There was no significant difference between left and right sides and sexes. There was significant difference among different ages (P < 0.05). (6) The sagittal pedicle angle: The in 12-13 years old, 3°-8°; in 14-15 years old, 0°-5°. The value decreased with age, and there was significant difference between men and women in L3-L4 (P < 0.05). (7) Pedicle area: The two groups had the same rules. L1-L5 gradually increased, and L4-L5 had a clear trend of change. (8) Analysis of pedicle parameters showed that the size of the screws in the lumbar vertebrae of normal adolescents was suitable for the clinician to grasp the anatomy of the lumbar spine and improve the accuracy of clinical operation.

Key words: adolescents, lumbar vertebrae, pedicle screw, morphological characteristics, three-dimensional reconstruction measurement, the National Natural Science Foundation of China

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