目的 探讨经椎弓根-肋骨途径置钉的安全性和牢靠性,找出较理想的进钉点.方法 6具成人胸椎尸体随机分为3组,A组经椎弓根途径置钉,B、C 2组以不同的进钉点经椎弓根-肋骨途径置钉.对3组螺钉的位置、钉道总长度及各组成部分的长度行影像学测量.结果 B、C 2组的误置率明显低于A组,B、C 2组间的误置率相当.B、C 2组钉道的总长度明显长于A组,B、C 2组间的钉道总长度相当.B组钉道的非骨性部分长度占钉道总长的百分比明显低于C组.结论 经椎弓根-肋骨途径置钉固定中上位胸椎的安全性和牢靠性有一定保障,横突中外1/3头侧是较为理想的进钉点.%Objective Study on the safety and solidity for the placement of screw fixation through pedicle-rib approach in upper thoracic vertebrae and the ideal marking. Methods Six embalmed human cadaveric thoracic spines were randomly divided into 3 groups. Standard pedicle screws technique was used in Group A and pedicle-rib approach was adopted in Group B and C,but marking for Group B and C were different. After setting screws, following data based on imageology were obtained,which included screw location,total length of screw channel in 3 groups, and length of various components of screw path in Group B and C. Results Misplacement rate of Group B and C were significantly lower than Group A . Misplacement rate of Group B and C was similar. The total length of the screw channel in Group A was shorter than Groups B and C, and that in Group B and C was not significantly different. Non-bony part of the screw channel was significantly lower in Group B than Group C. Conclusion The placement of screw fixation through pedicle-rib approach in upper thoracic vertebrae is safe and effective. The upper of transverse processes in the outer 1/3 should be selected as an ideal marking to enter vertebrae in pedicle-rib approach.
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