Sonone Sandeep, Dahapute Aditya Anand, Pal Mahendra, Virani Siddharth, Gala Rohan
Department of Orthopedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Craniovertebr Junction Spine. 2017 Apr-Jun;8(2):127-131. doi: 10.4103/jcvjs.JCVJS_5_17.
To determine the entry for the dorsal pedicular screw in relation to the notch present at the junction of base of the lateral margin of superior articular process with superior border of transverse process in dorsal spine. The advantage of this technique is a constant and easily identifiable entry point which does not involve partial resection of the inferior facet, thus maintaining stability and maintaining the well defined transverse and sagittal screw angles and decreasing the incidence of medial and inferior pedicle violation.
The study was carried out using ten cadavers (four male and six female). Spinal column was dissected completely from cadavers. Before the experiment, normal anatomy was confirmed on all cadavers excluding cases of spinal deformity. Dissection was done by the spine surgeons taking care to preserve all the bony landmarks near the entry point. This study was carried out bilaterally on pedicles between the first and twelfth thoracic (T) vertebrae.
The relation of the superior articular notch and transverse process to the thoracic spine pedicles was studied. It was found that superior third of the pedicle was related to the superior articular notch and the transverse process in the first five thoracic vertebrae. The relation of these structures to the pedicle of the sixth thoracic vertebra was somewhat equally distributed between the superior and middle third of the pedicle. From the 7 to 12 thoracic vertebrae the superior articular process and transverse process were related to the middle third of the pedicle in almost all the cases. It is important to note that the inferior 1/3 of the pedicle was not related to these landmarks at any of the levels.
We conclude that the ideal pedicle entry point described here should be considered by surgeons during thoracic pedicle screw instrumentation. The notch at the base of the superior articular process will always remain constant and therefore an important anatomical landmark in guiding the screw toward the entry of the pedicle.
确定胸椎椎弓根螺钉进钉点与胸椎上关节突外侧缘基部和横突上缘交界处的切迹的关系。该技术的优点是进钉点恒定且易于识别，不涉及下关节突部分切除，从而保持稳定性，维持明确的横向和矢状螺钉角度，并降低椎弓根内侧和下方侵犯的发生率。
使用十具尸体（四男六女）进行研究。将脊柱从尸体上完整解剖下来。实验前，在排除脊柱畸形病例的所有尸体上确认正常解剖结构。由脊柱外科医生进行解剖，注意保留进钉点附近的所有骨性标志。本研究在第一至第十二胸椎（T）椎弓根双侧进行。
研究了上关节切迹和横突与胸椎椎弓根的关系。发现前五节胸椎椎弓根的上三分之一与上关节切迹和横突相关。这些结构与第六节胸椎椎弓根的关系在椎弓根上三分之一和中三分之一之间分布大致相等。从第七至第十二胸椎，几乎所有病例中上关节突和横突与椎弓根中三分之一相关。需要注意的是，在任何节段，椎弓根下三分之一均与这些标志无关。
我们得出结论，胸椎椎弓根螺钉置入术中外科医生应考虑此处描述的理想椎弓根进钉点。上关节突基部的切迹始终恒定，因此是引导螺钉进入椎弓根的重要解剖标志。
