An Anatomical Observation Ofthoracolumbar Spine And Its Applications Of Scoliosis Deformity

Objective: To determine the anatomical relationship ofvertebral pedicle,nerve root and spinal cord by anatomical observation of the thoracolumbar spine.And then verify the anatomical landmarks during the clinical operation.To supplynew basis on the treatment of scoliosis and other diseases.Methods:(1)Anatomical observation: 15 normal adult spine specimens(30 laterals)were dissected layer by layeranatomically(group A).Its components thoracic vertebrae,lumbar vertebrae and vertebral pedicle,superior articular process,inferior articular process,basement of transverse process were exposed,and the transverse diameter of the middle pedicle,the angle between the axis of the pedicle and the coronal plane of the vertebral body,the angle of the midline of the vertebral body were measured with vernier caliper,protractor or triangle ruler respectively(with accuracy of 0.02mm),the data wasprocessed statistically;The angle of the middle diameter of the pedicle of the spine,the axis of the pedicle and the midline of the sagittal plane of the vertebral body of the 3 adjacent upper and lower vertebra of the diseased vertebra were measured in 6 cases clinically diagnosed hemi-vertebral malformation in group B and 6 cases clinically diagnosed idiopathic scoliosis in group C.To verify the results of the anatomical observation.(2)Clinical data: 30 patients with non-spine scoliosis were randomly divided into 3 Group,10 cases in each group,marked with D,E,F group.In group D,the transverse process and the superior articular process were employed to insert the punctureneedle.In group E,the herringbone method was used.In group F,the cross quadrant method and the vertical positioning methodwas adopted.All the operationswere performed by the same surgeon,and the average time per nail placement,the amount of surgical bleeding,and the accuracy of nail placement were compared respectively.The foregoing results were beneficial to the preoperative design of patients with scoliosis.Results:1.In Group A(15 spine specimens from normal adults),transverse diameter of the vertebral pedicle centreis 6.67±1.08(mm);In Group B(6spine specimens from semi-vertebral malformation patients),transverse diameter of the vertebral pedicle centreis 8.05±3.34;In Group C(6spine specimens fromidiopathic scoliosis patients),transverse diameter of the vertebral pedicle centreis 14.46±4.92.Group A is basically equal to Group B;Group A is smaller than Group C;Group B is smaller than Group C.2.In Group A,the angle between the pedicle axis and the coronal plane of the vertebral body is 24.25±6.90;In Group B,the angle between the pedicle axis and the coronal plane of the vertebral body is 19.83±4.08;In Group C,the angle between the pedicle axis and the coronal plane of the vertebral body is 26.30 ±7.22.Group A is basically equal to Group B;Group A is basically equal to Group C;Group B is smaller than Group C.In Group A,the angle between the pedicle axis and the median line of the sagittal plane of the vertebral body is 22.33±3.80;In Group B,the angle between the pedicle axis and the median line of the sagittal plane of the vertebral body is 21.75±2.66;In Group C,the angle between the pedicle axis and the median line of the sagittal plane of the vertebral body is 7.00±1.12.Group A and Group B are basically equal;Group A is larger than Group C;Group B is larger than Group C.3.The puncture needles are inserted into the thoracic and lumbar vertebral specimens through the traditional insertion point with the measured angles;the nail trajectory reaches the ideal position.The coverage of each insertion point is found in the outer upper quadrant of the cross quadrant.The origin of the cross quadrant is the intersection of the midline of the articular process and the one-third horizontal line of the transverse process.The outer boundary of the outer upper quadrant is the outer edge of the articular process,and the upper boundary is the base of the articular process.This area is a saferegion.At the same time,it is found that the insertion angle of the needle is almost 90° to the adjacent supraspinal ligament,and the safe range is within ±10°.The similar results are achieved in general spinal surgery with this method.4.The fixation time of group D is 5.5±1.1,the amount of bleeding is 25±3;the fixation time of group E is 5.1±1.2,the amount of bleeding is 20±3;the fixation time of group F is 3.1±0.6,and the amount of bleeding was 12±2;The accurate rate of insertion in three groups is 100%.In conclusion,in fixation time and the amount of bleeding,F group is significantly smaller than group D and group E.The accuracy of the three groups is equal.5.Preoperative design and treatment of patients with scoliosis: the insertion region is selected in the outer upper quadrant of the cross quadrant,and the insertion angle is vertical to the adjacent supraspinal ligament.The operation time is shortened and the amount of bleeding is reduced.The position of screw is satisfied in postoperative X-ray films.Conclusion: By anatomizing the thoracic and lumbar spine specimens from normal adults,it is concluded that there is a safe region in thoracolumbar spin for insert the puncture needles in normal adults.Within this region,the anatomical landmarks are easy to be revealed,the peeling of connective-tissues is less,and the operation span is less than traditional fixation method and the amount of bleeding is reduced.The "cross quadrant method" makes the identification of anatomical landmarks and determining the safe region of the insertion relatively simple and more accurate,and the method is easier to remember.The "vertical insertion method" uses the supraspinal ligament as a reference object to directly insert the needle with direct vision,and the insertion angle is within a reasonable range.Although the angle of vertebral body in scoliosis patients and even the spine has a hemivertebra deformity,the above anatomical landmarks are constant and the angle is fixed.The above-mentioned insertion method has a strong guiding significance for the technique of fixate the nail in the scoliosis surgery.The technology is relatively safe to operate,easy to master,and highly practical.