经肌间隙入路行下颈椎椎弓根螺钉置入的应用解剖与初步临床应用

doi:10.3760/cma.j.issn.1001-8050.2015.08.007

科研成果详情

题名	经肌间隙入路行下颈椎椎弓根螺钉置入的应用解剖与初步临床应用
其他题名	Subaxial cervical pedicle screw fixation through paraspinal approach: anatomic and clinical studies
作者	方弘伟 1; 袁登荣 2; 黄晓东 1; 高骏 1; 薛建喜 1; 杨平 1; 于继华 1; 朱胜玲 1; 邵建萍 1; 马维虎 3; 王向阳4; 陈德松 5
发表日期	2015-08-15
发表期刊	中华创伤杂志影响因子和分区
语种	中文
原始文献类型	学术期刊
关键词	颈椎解剖学椎弓根螺钉
摘要	目的探讨经颈、头半棘肌间隙手术入路下颈椎椎弓根螺钉置入的可行性及临床应用评价。方法选取成人尸体标本5具,解剖观察颈、头半棘肌间隙相关肌肉的起止与毗邻结构、颈深血管与颈神经后支走向,模拟置入C_3~C_7椎弓根螺钉50枚。临床采用头、颈半棘肌间隙入路行下颈椎椎弓根螺钉固定12例,置入螺钉49枚,观察手术创伤和并发症发生情况。CT评估螺钉位置。结果头半棘肌是肌间隙外侧的主要组成部分。颈半棘肌是构成肌间隙内侧的主要部分。多裂肌和回旋肌构成颈神经后支骨纤维管。肌间隙内、外侧组织分别由颈神经后内侧支和外侧支支配。颈深动脉在头、颈半棘肌之间上行营养两侧半棘肌。实验模拟置钉有6枚螺钉穿破管壁(6/50)。临床应用12例均顺利完成手术,术中颈、头半棘肌间隙易分离,有2枚螺钉穿破管壁(2/49),无置钉相关并发症发生。结论经头、颈半棘肌肌间隙入路为神经间平面,显露容易,创伤少,椎弓根螺钉置入方便,具有较好的临床可行性。
其他摘要	Objective To investigate the feasibility and clinical application of the cervical pedicle screw fixation through intermuscular planes between musculus semispinals cervicis and musculus semispinalis capitis. Methods Five adult specimens were selected for studying the anatomic features of musculus semispinalis cervicis and musculus semispinalis capitis and the distributions of surrounding deep cervical vassels and carotid nerve. Fifty cervical pedicle screws were placed into C_3-C_7 for all specimens. Besides, cervical transpedicular fixation with 49 screws was performed in 12 patients via the intermuscular planes between musculus semispinalis cervicis and musculus semispinalis capitis. Wounds and complications were detected after operation. Screw position was assessed by CT imaging. Results Musculus semispinalis capitis was the main part of the lateral intermuscular septum. Musculus semispinalis cervicis was the main part of the medial intermuscular septum. Multifidus and rotator participated in forming the cervical dorsal rami nerve bone fiber tube. Medial and lateral intermuscular tissues were dominated respectively by cervical dorsal medial branch and lateral branch. Deep cervical artery lied in upward branches between the semispinalis capitis and semispinalis cervicis, supplying both sides of the semispinalis. Six screws placed in the specimens cut through the pedicle wall. Screws were placed successfully in all the 12 patients. The plane between musculus semispinalis capitis and semispinalis cervicis could be separated easily. Four screws broke the pedicle wall, but there were no screw-related complications. Conclusions A new intermuscular plane through musculus semispinalis cervicis and musculus semispinalis capitis is developed to facilitate the low cervical pedicle screw insertion. Primary clinical results show cervical pedicle screw placement through the new approach is safe, feasible, easy and minimally invasive.
资助项目	浙江省医药卫生科技计划资助项目（2012KYA179）
ISSN	1001-8050
卷号	31 期号:08 页码:699-703
DOI	10.3760/cma.j.issn.1001-8050.2015.08.007
页数	5
收录类别	CNKI ; 维普 ; 北大核心 ; CSCD
学科领域	医药、卫生 ; 基础医学 ; 外科学
URL	查看原文
CSCD记录号	CSCD:5491351
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/48812
专题	第二临床医学院、附属第二医院、育英儿童医院_外科学_脊柱外科
作者单位	1.金华市中医医院骨伤三科; 2.浙江中医药大学第三临床医学院; 3.宁波市第六医院脊柱外科; 4.温州医科大学第二附属医院脊柱外科; 5.复旦大学附属华山医院手外科
推荐引用方式 GB/T 7714	方弘伟,袁登荣,黄晓东,等. 经肌间隙入路行下颈椎椎弓根螺钉置入的应用解剖与初步临床应用[J]. 中华创伤杂志,2015,31(08):699-703.
APA	方弘伟., 袁登荣., 黄晓东., 高骏., 薛建喜., ... & 陈德松. (2015). 经肌间隙入路行下颈椎椎弓根螺钉置入的应用解剖与初步临床应用. 中华创伤杂志, 31(08), 699-703.
MLA	方弘伟,et al."经肌间隙入路行下颈椎椎弓根螺钉置入的应用解剖与初步临床应用".中华创伤杂志 31.08(2015):699-703.