Angle of upper terminate plate parallel line of thoracolumbar vertebral body against the line between the percutaneous anatomic landmarks of the highest point of the spinous process

doi:10.3969/j.issn.2095-4344.1326

Abstract

Abstract:

BACKGROUND: Placement of thoracolumbar pedicle screws needs high technology and radiation exposure. Large amount of radiation makes serious effects on patients and the surgeons.

OBJECTIVE: To introduce a percutaneous pedicle screw placement technique with reference to the percutaneous anatomic landmarks of the highest point of the spinous process, so as to effectively reduce intraoperative radiation exposure.

METHODS: One hundred cases of normal thoracolumbar MRI were recruited and were divided into normal weight group and obese group. The angle of connection between the percutaneous anatomic landmarks of the highest point of the spinous process and the corresponding line between the parallel lines of the endplate was measured. At the same time, 100 cases of thoracolumbar MRI with thoracolumbar fracture were collected and divided into normal weight group and obese group. The same method was used to measure the angle between the two lines in adjacent vertebral segments (T₁₂ and L₁). The measured angle values of the fracture group and the normal group were compared and analyzed statistically to obtain the angle of the line between percutaneous anatomic landmarks of the highest point of the spinous process and the upper terminate plate.

RESULTS AND CONCLUSION: (1) The angle of the parallel lines of the endplate against the line between percutaneous anatomic landmarks of the highest point of the spinous process was 87-95° at T₁-L₄in the normal weight group, while the angle was 86-94° at T₈-L₂ in the obese group. The average angle was 90°. (2) The measured angle in thoracolumbar fracture group was around 90°. There was no significant difference between the normal group and the fracture group (P > 0.05). (3) In summary, if we keep the connection angle between the line between percutaneous anatomic landmarks of the highest point of the spinous process and the pedicle screws is about 90° in the thoracolumbar vertebral fracture fixation surgical procedure, we basically can ensure that the pedicle screw parallel to the upper terminate plate. The method of this percutaneous pedicle screw placement with reference to the percutaneous anatomic landmarks of the highest point of the spinous process is a safe, effective technique for treating the spinal fracture.

Key words: thoracolumbar fracture, line between the percutaneous anatomic landmarks of the highest point of the spinous process, minimally invasive, percutaneous, pedicle screws, internal fixation, screw angle of sagittal plane

CLC Number:

R459.9|R445.2|R318

Ma Jian, Zhang Meng, Liu Huan, Wang Shouguo. Angle of upper terminate plate parallel line of thoracolumbar vertebral body against the line between the percutaneous anatomic landmarks of the highest point of the spinous process[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4485-4490.

Figures/Tables 3

表4中统计角度分析可见，正常组肥胖患者MRI上棘突顶点皮缘连线与椎体上终板平行线交角T1-T7均值范围89.886°-100.511°，标准差范围为3.334°-3.865°，角度数值离散程度高，波动大。T8-L2均值范围88.325°-89.792°，标准差范围1.426°-2.280°，角度基本接近90°即垂直位。L3-L5均值范围85.364°-91.617°，标准差范围为7.294°- 9.222°，角度数值离散程度高，波动大。从中得出结论，对于肥胖患者从T8-L2，如果椎弓根螺钉置入时矢状面上垂直于棘突顶点皮缘连线，那么螺钉将平行于上终板。 2.6 骨折组测定结果此次试验主要将L1骨折椎体临近的上下椎体进行了测量，即T12及L2棘突顶点皮缘连线与椎体上终板的交角。正常体质量者角度测量结果：T12平均值为(88.75±2.10)°，标准差为2.10°，L2平均值为(92.19±2.68)°，标准差为2.68°。肥胖患者角度测量结果：T12平均值为(89.34±2.80)°，标准差为2.80°，L2平均值为(93.37±2.45)°，标准差为2.45°。将肥胖患者T12，L2统计结果以散点图绘出，见图6，7。测量结果可见：T12角度范围82°-93°，L2角度范围80°-96°，散点基本分布在90°左右，说明骨折椎体的临近节段也基本在垂直位。2组数据分别与健康对照组进行比较，结果显示，T12：t=1.640，P > 0.05；L2：t=0.627，P > 0.05，按α=0.05计算，差异无显著性意义，说明椎体骨折对邻近节段棘突顶点皮缘连线与椎体上终板平行线夹角无明显影响。通过2组数据对比分析，总结得出以棘突顶点皮缘连线作为椎弓根螺钉矢状面进钉角度的参照在理论上是可行的。 2.7 植入物与宿主的生物相容性骨折组植入物置入后出现局部感染2例，无过敏反应、免疫反应及排斥反应发生。 2.8 不良反应骨折组患者出现局部感染2例，静脉血栓形成1例。 "

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