Ko pedicle screws inoiswa sei?

Pedicle screw placement nzira

1. Nzvimbo yekupinda: mutsipa, chifuva uye chiuno zvakasiyana;

2. Bata horizontal plane angle (TSA) uye sagittal plane angle (SSA) yescrew entry: Iyo TSA angle inogona kuyerwa kubva mufirimu reCT. Iyo SSA ine humwe hukama nenzvimbo yemuviri, uye inogona kudzorwa neC-ruoko panguva yekushanda.

3. Kudzika: Kureba kwekona kunosvika 80% yehurefu hwe pedicle axis kuwana simba rakakwana rebiomechanical, uye zviri nyore kupinda mukati me cortical bone uye kukuvadza mitsipa yeropa kana yakareba.

4. Kureba: kubva pakupinza tsono kusvika ku83% yehurefu hwose hwe anterior cortex ye vertebral body.

Cervical Spine

Cervical pedicle screw yekupinza nzira

Kupinza tsono nzira

Parizvino, nzira huru dzekuisa tsono ndeidzi: Abumi nzira, anatomical landmark yekumisikidza nzira, komputa-inobatsira imaging yekumisikidza nzira, nezvimwe.

cervical spine entry point

• Pamharadzano ye5mm pazasi pemutsara wakatwasuka wepamusoro pemucheto welamina yeC2 axis uye 7mm kunze kwemukati wepakati wepelinha canal.

• C3-C6 Mharadzano yekumusoro yepakati 1/4 mutsara wakatwasuka uye wepakati wekunze 1/4 mutsara wakatwasuka kuseri kwechivharo chedivi.

• C7 Mharadzano ye vertical midline ye lateral block uye yepamusoro yepakati 1/4 horizontal line iri pamusoro.

  
  

Cervical vertebra screwing angle

• C2 kurerekera 20-25° kurerekera 10-15°

• C3-C6 inorereka 40-45 °, iyo yakatwasuka ndege inofanana neyokumusoro uye yakaderera endplates.

• C7 inclination 30-40 °, iyo yakatwasuka ndege inofanana nepamusoro uye yakaderera endplates.

  
  

Cervical spine screw

• C1～C5 inoda screws ane dhayamita ye3.5mm uye kudzika kwe20mm

Kana kureba kweiyo posterior arch yeatlas isingasviki 4mm, inoshandurwa kuita lateral mass screw.

Kana kureba kana hupamhi hwe pedicle yeaxis iri pasi pe5mm, zvinokurudzirwa kuchinja kune lateral mass screw fixation.

Cervical lateral mass screw kuiswa

Magerl's method : Iyo screw entry point inowanikwa 1-2mm pamusoro pepakati peiyo posterior rusvingo rwe lateral mass; screw entry direction is 25-30 ° laterally inclined, uye musoro wakarereka 30 ° (unoenderana nechepamusoro articular surface), uye contralateral cortex inoboorwa; kuyerwa kwakadzika Mushure mekupeta mu 3.5mm cortical bone screws.

Roy-Camille nzira : iyo screw entry point iri pakati pekuseri kwe lateral mass; screw entry direction ndeye 10 ° nechemberi, vertical posterior cortex inoboorwa, uye contralateral cortex inoboorwa; mushure mekurira, 3.5mm cortical bone screw inopindirwa mukati.

Anderson's method : The screw entry point inowanikwa 1mm mukati mepakati pe lateral mass, screw entry direction is 20° laterally, uye musoro wakarereka 20° kusvika 30° kuboora gomba, uye contralateral cortex inoboorwa.

Sangana muchidimbu

(1) Kunyanya kutarisisa kunofanirwa kubhadharwa kune chengetedzo yekuisa screw. Chiremba anovhiya anofanira kusarudza nzira yakakodzera maererano nehunyanzvi hwecervical anatomy uye pedicle screw technique.

(2) The lateral mass screw fixation muchikamu cheC3-C6 iri nyore uye yakachengeteka kudarika pedicle screw fixation.

(3) Chishandiso hachigone kupinda mumadziro ekunze e pedicle, zvikasadaro ichakuvadza tsinga dziri pedyo nemidziyo yeropa.

(4) Kona yekupinza screw inofanira kusiyanisa nekona ye vertebral arch.

(5) Kupinda kwe cortical bone pamberi pe vertebral body inofanira kudziviswa.

(6) Intraoperative fluoroscopy inogona kunyatsoona iyo vertebral body uye intervertebral space, uye yakanyatso kupinza screws kudzivirira screwing mukati me intervertebral space uye spinal canal.

Thoracic

Needle yekupinda nzvimbo:

1. Margel naRoy Camille vakatora mharadzano yemutsara wakatwasuka wepakati penzira yekuchinjika uye mutsara wakatwasuka wemupendero wekunze weiyo yepamusoro articular process senzvimbo yekupinda.

2. Ebraheim akaronga kuti pakati pe pedicle ye T1-T2 inowanikwa 7-8 mm mukati memucheto wekunze wepamusoro we articular process, uye 3-4 mm pamuganhu wepakati pekugadzirisa. ~8mm.

3. Dhirowa mutsara wakatwasuka 3 mm kunze kwepakati pejoini rezasi, uye dhirowa mutsara wakatwasuka kubva kumusoro 1/3 yenheyo yenzira inochinjika, uye mharadzano yemitsara miviri ndiyo nzvimbo yembambo yembambo.

4. Pamharadzano yepakati peiyo longitudinal axis yeyakaderera articular process uye yakatwasuka mutsara wepakati pemudzi weiyo transverse process, 1 mm pazasi pechiso;

5. Muzviitiko zvakaoma, isarudzo yakachengeteka kubvisa chikamu chelamina uye kuisa pedicle screws pasi pechiratidzo chakananga.

Thoracic musana wokupinza angle

Sagittal plane : Kuderera kwe pedicle inclination kubva T1 kusvika T12. T1: 25°; T2: 20°; T3: 15°; T4-9: 10°; T10: 5°; T11-12: 0°.

Iyo pedicle screws yekumusoro thoracic vertebrae inofanira kunge ine inclination angle ye 10-20 ° nesagittal plane, uye pedicle screws yepakati uye yakadzika thoracic vertebrae inofanira kuva nekona ye 0-10 ° nesagittal plane. Ebraheim akakurudzira kuti T1 uye T2 pedicle screws inofanira kuva 30-40 ° inorereka nesagittal ndege, T3-T11 inofanira kuva 20-25 °, uye T12 inofanira kuva 10 °.

Horizontal plane : inofanira kuenderana nepamusoro uye yakaderera endplates.

Thoracic musana sarudzo screw

• T1～T5 inoda sikuruwa dhayamita 3.5 ~ 4.0mm

• T6～T10 inoda 4.0—5.0mm

• T11, T12 inoda 5.5mm

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Kune vanhu vakuru, dhayamita ye thoracic pedicle screw iri pasi pe5mm, uye kune ngozi yekuputsika kwe screw. Muzviitiko zvakawanda zvepakati pethoracic musana, screws yakakura kudarika 5 mm muhupamhi haigoni kuiswa, iyo inogona kutungamirira nyore nyore pedicle kuputika.

Dzimwe nyanzvi dzinoshandisa lateral kuiswa kwe pedicle, iyo inogadzirisa dambudziko iri zvakanaka. Dzvanya muromo weiyo transverse process kuti uise pini, uye yepakati peiyo transverse process yakachinjika. Shandura buri diki kutanga, uye kutungamira kweawl kunopindirana ne lateral edge ye facet joint ye vertebra. Iyo kona ine sagittal ndege ndeye 25-40 madhigirii, uye dhigirii zvishoma nezvishoma inowedzera kubva T12 zvichikwira.

Iyo screw yakaiswa ichapfuura nemuchinjika process, chikamu che costotransverse process, costovertebral joint, uye lateral madziro e vertebral body. Sezvo nzira yekuisa screw iri kunze kweiyo facet joint, hazvibviri kupinda mugero remusana, iro rakachengeteka. Mukuwedzera, kuwedzera kwekona yekona kunoita kuti screw irebe. , yakakora, simba rekugadzirisa rinowedzerwa, iyo yekuisa angle range yakakura, screws inogona kuwanikwa mumutsara, uye gungano rinonyanya nyore.

Lumbar musana

Lumbar entry point

1. Nzira yekuisa tsono panhongonya yeherringbone ridge (nzvimbo yekusangana yezvigadziro zvekushandisa padivi remashure remudzi wepamusoro-soro articular process uye isthmus ridge), kusiyana kwechinzvimbo ichi kuduku (chinoitika chiitiko 98%), uye nzira yekuwedzera inorumwa nekuisa.

2. Mharadzano nzira: mharadzano yepakati peiyo axis yakachinjika yeiyo transverse process uye longitudinal axis kunze kweiyo facet joint, kana kumucheto kwekunze kweiyo yepamusoro articular process,

3. Muzviitiko zvakaoma, isarudzo yakachengeteka kubvisa chikamu chelamina uye kuisa pedicle screws pasi pechiratidzo chakananga.

Lumbar screw angle

• Sagittal plane angle : L1-L3 ine 5-10 madhigirii ekushandura, L4-L5 ine 10-15 madhigirii ekushandura.

• Horizontal plane angle : L1-4: inopindirana kune endplate; L5: 10 madhigirii ekudzika pasi (L5 vertebral body kumashure).

  
  

Lumbar spine sarudzo screw

• L1～L5 inoda sikuruu dhayamita 6.5mm, 40-45mml sikuruu

  
  

Kuvhiya Kuchengetedza

1. Usati wavhiyiwa, panofanira kunge kune maonero akajeka epamberi uye lateral ye lumbar spine. Maonero epamberi anoratidza nzvimbo ye screw munzira yakatwasuka, uye lateral maonero anogona kuratidza nzvimbo ye screw munzvimbo yakatwasuka.

2. Nzvimbo yekupinda inofanira kuva yakarurama uye yakawedzerwa zvakakodzera, uye cortical bone panzvimbo yeanchor inogona kubviswa nekuzarura piramidi ye triangular kana rongeur.

3. Mushure mekuona hutungamiri huzhinji, shandisa simba rakakodzera kuti uvhure dunhu zvakanyatsonaka. Iyo blunt-tip probe haifanirwe kusangana nekupikisa kuri pachena panguva yekuiswa tsono. Hapafanirwe kuve nepfungwa yeku 'kutadza' kana kuramba kukasira. Kana kushorwa kunowanikwa mune yekutanga 5 ~ 15mm, inofanira kunge iri panguva. Rongedza tsono yekupinda poindi uye kona. Kana iwe ukasangana nekupikisa kwakasimba, zvinokurudzirwa kuti ubve pakutanga uye sarudza zvakare nzira yekupinda. Iva nechokwadi chekutevera nzira ye pedicle. Iyo yemukati ye pedicle ndeye cancellous bone uye kunze i cortical bone, iyo inogona kutungamirirwa yakasununguka, kunze kwekuti nzvimbo yekupinda yakarurama uye yakawedzerwa zvakakodzera; Enzanisa 10-15 ° kusvika pakati, teerera kune ndege inofananidzwa nepamusoro pemucheto we vertebral body, uye ubate kudzika kwe 3cm. Kunzwa kwakakosha.

4. Zvinonyanya kukosha kushandisa pedicle probe kuongorora masvingo mana, kunyanya mukati, pasi uye pasi masvingo.

5. Kana mutsauko weanatomical pakati pezasi pe thoracic uye lumbar vertebrae isinganzwisisike, ruma kubva kune iyo accessory process uye yakaderera articular process, uye wobva waruma zvishoma kubva kumusoro articular process, uye tarisa zvakananga kumadziro emukati e pedicle uye musuwo we pedicle.

6 Zviri nani kubuda kunze pane kupinda mukati, kukwira usingaburuki; kutenderera ndicho chinhu chikuru, uye mberi ndiko kuwedzera; paunenge uchifambira mberi uye uchiongorora, mira paunoona zvakaoma, gadzirisa nekufamba kwenguva, shandisa simba remunwe chete, usatsveta nesimba.

7. Iyo dhayamita ye screw haifaniri kudarika 83% yehupamhi hwekunze cortex ye pedicle.

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