林瀚++++++彭吾训

[摘要] 人字嵴顶点法是徒手置入腰椎椎弓根螺钉最常用的方法之一，本文从进钉点定位、人字嵴出现率、毗邻结构、进钉点与椎弓根轴线的关系、轴向最大拔出力、置钉角度、进钉深度、手术时间、出血量及手术效果等方面对其进行介绍。腰椎人字嵴变异少，其顶点与椎弓根轴线吻合较好。人字嵴顶点法在一定程度上克服了十字定位法的不足，手术显露范围较小，易于显露，置钉前切口显露时间短，术中出血量少，并发症少，置钉准确率高，椎弓根螺钉固定牢靠。

[关键词] 人字嵴；腰椎；椎弓根螺钉；进钉点

[中图分类号] R681.5 [文献标识码] A [文章编号] 1674-4721（2016）02（a）-0013-04

Advance in related research of herringbone crest vertex technique

LIN Han PENG Wu-xun▲

Guizhou Medical University，Guiyang 550000，China

[Abstract] Herringbone crest vertex technique is one of the techniques which are used the most commonly for inserting lumbar vertebra pedicle screws manually.The location of entrance point，appearing rate of herringbone crest，adjacent structures，relationship between entrance point and pedicle axis，maximum of withdrawal force，angle and depth of screw insertion，time of operation，amount of bleeding and effect of operation are described by this paper to introduce it.Herringbone crest of lumbar vertebra is hardly variant and the vertex of it shows good agreement with pedicle axis.Herringbone crest vertex technique overcomes the shortcomings of cross location technique to some extent，which is easy to expose and needless to expose too much in the operation.The exposing time of incision is short before pedicle screw，the amount of bleeding during operation and the complication is little，the accuracy of pedicle screws is high，pedicle screws is secure.

[Key words] Herringbone crest；Lumbar vertebra；Pedicle screw；Entrance point

目前，经后路置入椎弓根螺钉是脊柱外科手术中最常用的内固定方法[1]。脊柱椎弓根螺钉把持力强，内固定技术对脊柱的矫形能力较好，并且可实现三柱固定[2-5]。成功置入椎弓根螺钉的关键是要确保螺钉能准确地通过椎弓根到达椎体前部，如果进钉错误，则可能导致椎弓根皮质破裂、大血管损伤、硬脊膜破裂及脊髓或神经根损伤等严重后果[6-8]。在脊柱手术中，椎弓根解剖结构的复杂性及特殊性给椎弓根螺钉的准确置入带来不少困难。众所周知，腰椎骨折、腰椎间盘突出症、腰椎滑脱症、退变性腰椎管狭窄症等腰椎疾患是脊柱外科的常见疾病，治疗上述腰椎疾患往往需要手术，而手术中往往需要置入椎弓根螺钉进行内固定，因此如何准确置入腰椎椎弓根螺钉一直以来都是广大学者所关注的问题。……