The Clinic Applied Anatomic Study: The Screw Fixation Of Pedicle Of The First Thoracic Vertebral Arch

Thoracic injury patients often have serious adverse consequences. With the aging of human society, as well as transportation, industrial and construction accidents, diseases of high incidence of thoracic injury incidence is rising, the timely and efficient treatment of thoracic injury has an extremely important practical significance. On the surgical treatment of thoracic injury, the purpose can be summed up as follows: the normal thoracic anatomic reduction; stability and reconstruction of thoracic nerve root or spinal cord decompression. Thoracic fixation is to achieve an effective means to these ends, appropriate fixation, can help to correct or prevent deformity of thoracic anatomy of sequence changes in the provision of immediate stability and conducive environment for fusion, and ultimately to restore the stability of the thoracic spine.Thoracic pedicle screw device with the anterior and posterior rod hook device compared a number of advantages: the ability to provide a strong fixation, orthopedic better results, can increase the bone-bed area, to reduce the bleeding. However, as in the spinal cord and medial pedicle bone wall, only between 1 ~ 2 mm of epidural space, and in front of large blood vessels and the pleura, spinal cord injury, blood vessels and the risk of pleural great. Nevertheless, some scholars still believe that a small medial wall of pedicle perforation does not necessarily result in spinal cord injury. The correct application of pedicle screw Pedicle screws need to be aware of the anatomy, including the method of screw placement, but also to understand the situation of patients with bone, as well as the form of screws, as well as after the failure of the determination of remedial measures.By pedicle screw fixation in spinal surgery technology is the fastest growing one fixation. At present, the pedicle screw fixation of posterior spinal surgery has become an important method. Posterior fixation and fusion devices commonly used in trauma, degeneration, cancer, deformities such as resulting from the treatment of spinal instability. By pedicle screw fixation can provide a strong attachment point. Although on the thoracic spine pedicle anatomy, bio-mechanics study reported a gradual increase, but by the pedicle screw fixation in thoracic spine fractures and spinal deformity correction in a wide range of applications benefit is still controversial. Unique to the thoracic spine pedicle anatomy and its relationship with neighboring spinal cord and nerve root in-depth understanding of the relationship can be fixed by the thoracic pedicle screw-related complications reduced to a minimum.Most of the anatomical study of the past is based on the projection of pedicle axis to determine the nail home the above data, so each point of the pedicle screw of the home are not all the same, E are not the same angle, and the youngest is 7. , The largest 50. , F Kok 10-20 are the first dump. , Makes the point of view of the first dumping nails on Road and vertebral end-plate is not parallel, that is not a good intensity eyesores created, which do not meet the actual clinical application. First, make sure that they are the data is correct, the application or even inconvenient to not be able to connect is also obvious, reason is detached from the clinical study.T1 is located at Cervicothoracic junction of the Department of Transitional, anatomical complexity, variability, and the horizontal angle of up to 45. , Sagittal plane, as the anterior chest after the song and the song changes the perspective, the longitudinal angle is also changing. T1 vertebral body adjacent to major vessels and nerves and organs, home nail a high degree of difficulty and risk, in the past been included in the restricted area of the pedicle screw home. If the existence of rotation (coronal and sagittal plane) and the change in position, so that previous studies have changed the frame of reference, to the right brought home the difficulties nails. Clinical application of a result from the reality of a relatively constant frame of reference is particularly important and necessary. In this study, the application of clinical reality, the 15 adult specimens corresponding T1 dry cutting, measurement of pedicle screw and buy the corresponding data.Objective: From the reality of clinical application, given T1 Pedicle screw database T1 Pedicle screw on the scientific nature, feasibility, safety and practical answer to the clinical application of this method to provide the anatomical theory.Method:①isthmus: the lower edge of the articular process, articular process of the upper edge of projection in the lamina, transverse process on the root of the medial and lateral margin of the medial facet of the surrounding area.②home nail point: both sides of the transverse process on the edge of a ridge, transverse ridge of the roots as a horizontal line connecting both sides of the vertebral body and along the outer edge of the next facet of the point of intersection of the two vertical sides of the pedicle as nail home the point.③nails the way home: home nails along both sides of the connection points to parallel to the T1 on the end-plate cutting T1. In this section T1 pedicle axis on the basis of a nail home. Of the vertebral body and do the cutting, and survey data: the pedicle axis of the bone channel length (TL), cutting plane narrowest pedicle width (PW), E Kok (the pedicle axis in the horizontal surface projection and the vertebral body into the middle sagittal plane angle), the pedicle isthmus horizontal axis and the side angle (set at angle A), the pedicle isthmus longitudinal axis and side angle (set at angle B). Data using SPSS software for statistical analysis.Result: The mesurring rusult of the the first thoracic vertebral arch:P(Wmm): 7.52±0.62(6.50～8.70);TL (mm): 34.64±2.32(30.12～38.44);angleE(。): 34.8±2.9(30.3～41.9);angleA (。): 89.7±2.9(85.9～94.8);angleB (。): 89.1±3.2(85.1～93.3).Conclusion: Both sides of the transverse process on the edge of a ridge, transverse ridge of the roots as a horizontal line connecting both sides of the vertebral body and along the outer edge of the articular process of the two perpendicular intersection point of the home as a pedicle screw on both sides, the to perpendicular to the vertebral isthmus as the direction of home purchase nail nails method is safe, scientific and feasible. Isthmus is a relatively constant frame of reference perpendicular to the nail isthmus home easy, practical, clinical applications can achieve the requirements of the individual.