Xuan Jun, Zhang Di, Jin Hai-Ming, Chen Jiao-Xiang, Xu Dao-Liang, Xu Hong-Ming, Wu Yao-Sen, Wang Xiang-Yang
Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China.
Department of Orthopaedic Surgery, Affiliated Cixi Hospital of Wenzhou Medical University, Cixi, Ningbo, 315300, People's Republic of China.
Eur Spine J. 2016 Dec;25(12):4199-4207. doi: 10.1007/s00586-016-4730-y. Epub 2016 Aug 23.
To evaluate the feasibility of cortical bone trajectory (CBT) screws fixation via pedicle or pedicle rib unit in the cadaveric thoracic spine (T9-T12).
Computed tomography (CT) images of 100 patients are analyzed by multiplanar reconstruction. Ten cadaveric thoracic spines are used to insert 4.5 × 35.0 mm CBT screws at all levels from T9 to T12.
Maximal screw length obtained by CT has a tendency to gradually increase from T9 (29.64 mm) to T12 (32.84 mm), and the difference reaches significant level at all levels except T9 versus T10 (P < 0.01). Maximal screw diameter increases from T9 (4.92 mm) to T12 (7.47 mm) and the difference reaches significant level among all levels (P < 0.01). Lateral angle increases from T9 (7.37°) to T12 (10.47°), and the difference reaches significant level among all levels except T11 versus T12. Cephalad angle from T9 to T12 are 19.03°, 22.10°, 25.62° and 27.50° (P < 0.01), respectively. The percentage of the inner and outer pedicle breakage are 2.5 and 22.5 %, respectively. The violation of lateral pedicle wall occurs at T9 and T10, especially for women at T9.
Both radiographic and cadaveric studies establish the feasibility of CBT screws placement via pedicle or pedicle rib unit in the lower thoracic spine (T9-T12). Furthermore, our measurements are also useful for application of this technique.
评估在尸体胸椎（T9 - T12）中经椎弓根或椎弓根肋骨单元置入皮质骨轨迹（CBT）螺钉固定的可行性。
通过多平面重建分析100例患者的计算机断层扫描（CT）图像。使用10具尸体胸椎，在T9至T12的所有节段置入4.5×35.0 mm的CBT螺钉。
CT测量得到的最大螺钉长度从T9（29.64 mm）至T12（32.84 mm）有逐渐增加的趋势，除T9与T10外，各节段间差异均达到显著水平（P < 0.01）。最大螺钉直径从T9（4.92 mm）增加至T12（7.47 mm），各节段间差异均达到显著水平（P < 0.01）。外侧角从T9（7.37°）增加至T12（10.47°），除T11与T12外，各节段间差异均达到显著水平。T9至T12的头侧角分别为19.03°、22.10°、25.62°和27.50°（P < 0.01）。椎弓根内侧和外侧破损的百分比分别为2.5%和22.5%。椎弓根外侧壁侵犯发生在T9和T10，尤其是T9节段的女性。
影像学和尸体研究均证实了在胸椎下段（T9 - T12）经椎弓根或椎弓根肋骨单元置入CBT螺钉的可行性。此外，我们的测量结果对该技术的应用也具有指导意义。
