胸椎椎弓根螺钉植入 Pedicle screw insertion in the thoracic spine

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1. 引言

胸椎椎弓根螺钉可用于治疗胸椎及其邻近节段的创伤、畸形、肿瘤和退行性疾病。

Pedicle screws in the thoracic spine may be used in the management of trauma, deformities, tumors, and degenerative conditions of the thoracic spine and its neighboring segments.

2. 准备工作 Preparation

一旦脊柱暴露出来，就用图像增强器确认合适的固定水平。

Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier.

3. 创伤后不稳定的损伤 Unstable injuries after trauma

在不稳定的损伤中，由于位移和旋转，损伤水平以上和以下的节段可能具有不同的椎弓根轨迹方向。

在严重不稳定的损伤中，在使用椎弓根锥子时必须注意不要造成更多的移位。

必要时，必须获得起点和轨迹的图像增强器确认。

必须对所有级别的器械进行术前椎弓根完整性评估。

In unstable injuries, the segments above and below the level of injury may have a different orientation of pedicle trajectory due to displacement and rotation.

In severely unstable injuries, care must be taken not to cause more displacement while using the pedicle awl.

Whenever necessary, image intensifier confirmation of the starting point and trajectory must be obtained.

Preoperative assessment of pedicle integrity must be done for all levels of instrumentation.

4. 标记点 Landmarks

标记点：

• 上关节面的外侧缘
• 下关节面的外侧缘
• 关节间部嵴
• 中横突
  

Landmarks:

• Lateral border of the superior articular facet
• Lateral border of the inferior articular facet
• Ridge of the pars interarticularis
• Mid transverse process
  

5. 胸椎的入口点 Entry points in the thoracic spine

椎弓根螺钉入口点和胸椎成角可根据椎弓根与关节面和横突的关系分为四组。

在确定小关节中部与横突上缘的交点后，确定下胸段椎弓根螺钉的入口点。特定的入口点将只是该交叉点的外侧和尾部。

当您移动到更近端的胸椎水平时，入口点往往更头侧。

Pedicle screw entry points and angulation in the thoracic spine can be divided into four groups based on the relation of the pedicle with the articular facets and the transverse process.

The entry point of the pedicle screw for the lower thoracic segments is defined after determining the intersection of the mid portion of the facet joint and the superior edge of the transverse process. The specific entry point will be just lateral and caudal to this intersection.

The entry point tends to be more cephalad as you move to more proximal thoracic levels.

T1–T3

入口点位于水平绘制的线的交点处，该线通过横突的中间绘制，一条线绘制在关节面中心略微横向。

T1–T3

The entry points is in the intersection of the line drawn horizontally though the middle of the transverse process with a line drawn slightly lateral to the center of the articular facet.

螺钉角度略微内侧和尾部。

The screw angulation is slightly medial and caudal.

T4–T6

与 T1-T3 入口点相比，入口点更倾向于颅骨和内侧。入口点位于水平穿过横突上1/3的线与穿过关节面中心绘制的线的交点处。

T4–T6

The entry point is more cranial and medial compared to the T1–T3 entry points. The entry point is in the intersection of the line drawn horizontally through the upper 1/3 of the transverse process and the line drawn through the center of the articular facet.

螺钉角度几乎是垂直的。

The screw angulation is almost vertical.

T7–T9

与 T4-T6 入口点相比，入口点更倾向于颅骨和内侧。入口点位于横突上边界上水平绘制的线与关节面中心线略内侧绘制的线的交点。

T7–T9

The entry point is more cranial and medial compared to the T4–T6 entry points. The entry point is in the intersection of the line drawn horizontally on the superior border of the transverse process and the line drawn slightly medial to the center line of the articular facet.

螺杆角度是垂直的。

The screw angulation is vertical.

T10–T12

这些蒂往往非常窄。入口位于通过突或横突上 1/3 绘制的水平线与通过关节面中心绘制的垂直线的交点处。

T10–T12

These pedicles tend to be very narrow. The entry is in the intersection of a horizontal line drawn through the mammillary process or the upper 1/3 of the transverse process, and the vertical line drawn through the center of the articular facet.

螺钉角度是垂直的或略微横向的。

The screw angulation is vertical or slightly lateral.

如果不确定蒂的入口点是否正确，则进行去除黄色韧带的小型椎板切开术将允许用 Pennfield 或球尖探头触诊蒂内壁。

If one is not sure the entry point for the pedicle is correct, a small laminotomy with removal of the yellow ligament will allow palpation of the inner wall of the pedicle with either a pennfield or a ball-tip probe.

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