椎板上营养孔的位置为椎弓根螺钉置入提供了一个标志：一项尸体研究。
Nutrient foramen location on the laminae provides a landmark for pedicle screw entry: a cadaveric study.
作者信息
Oshina Masahito, Oshima Yasushi, Matsubayashi Yoshitaka, Taniguchi Yuki, Chikuda Hirotaka, Riew Kiehyun Daniel, Tanaka Sakae
机构信息
Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
Department of Orthopedic Surgery, Columbia University, New York, NY, USA.
出版信息
BMC Musculoskelet Disord. 2018 Aug 16;19(1):293. doi: 10.1186/s12891-018-2218-0.
BACKGROUND
Nutrient foramina are often encountered around the entry point of pedicle screws. Further, while probing the pedicle for pedicle screw insertion around the nutrient foramen, bleeding from the probe insertion hole is often observed. The purpose of this study was to investigate the frequency of occurrence of nutrient foramina, the association between the nutrient foramen and pedicle, and the safety and accuracy of cervical and thoracic pedicle screw placement using the nutrient foramen as the entry point.
METHODS
We identified the location of the nutrient foramina for the dorsal branches of the segmental artery and their anatomical association to the pedicles and bony landmarks in the vertebrae for C3-T12 in seven cadavers. We also determined the frequency with which the nutrient foramina were present in 119 cadaveric vertebrae. We identified the pedicle location, base of the superior articular facet, and lateral border of laminae with respect to the nutrient foramen.
RESULTS
The overall presence of the nutrient foramina was 63% (150/238) in the specimens, with 60% (42/70) and 64% (108/168) identifiable in the cervical and thoracic vertebrae, respectively. In the cervical vertebrae, the nutrient foramen was located on the outer wall of the pedicle and was positioned between the cephalad and caudal walls. In the thoracic spine, 98% (106/108) nutrient foramina were located inside the pedicle walls.
CONCLUSIONS
Our study findings confirm that the location of the nutrient foramen can be used for identifying the entry point for pedicle screws. In the cervical vertebrae, the nutrient foramina are located lateral to pedicle but within the cranial and caudal margins. In the thoracic vertebrae, the nutrient foramina are located in the medial and caudal regions of the pedicle. Thus, to decrease the risk of overshoot, the entry point for thoracic pedicle screws should be positioned a few millimeters cephalad and lateral to the nutrient foramen.
背景
在椎弓根螺钉置入点周围常可发现滋养孔。此外，在滋养孔周围探查椎弓根以置入椎弓根螺钉时，常可见到探针插入孔处出血。本研究的目的是调查滋养孔的发生率、滋养孔与椎弓根的关系，以及以滋养孔为置入点进行颈椎和胸椎椎弓根螺钉置入的安全性和准确性。
方法
我们在7具尸体上确定了节段动脉背支滋养孔的位置及其与C3-T12椎体椎弓根和骨性标志的解剖关系。我们还确定了119个尸体椎体中滋养孔的出现频率。我们确定了相对于滋养孔的椎弓根位置、上关节突基部和椎板外侧缘。
结果
标本中滋养孔的总体出现率为63%（150/238），颈椎和胸椎中分别为60%（42/70）和64%（108/168）。在颈椎中，滋养孔位于椎弓根外壁，位于头侧和尾侧壁之间。在胸椎中，98%（106/108）的滋养孔位于椎弓根壁内。
结论
我们的研究结果证实，滋养孔的位置可用于确定椎弓根螺钉的置入点。在颈椎中，滋养孔位于椎弓根外侧，但在头侧和尾侧边缘内。在胸椎中，滋养孔位于椎弓根的内侧和尾侧区域。因此，为降低过深置入的风险，胸椎椎弓根螺钉的置入点应位于滋养孔头侧几毫米并向外侧。
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