摘要
目的研究寰椎后弓交叉螺钉固定的解剖学可行性，以提供可供选择的寰椎固定方法。方法对10具寰椎标本进行实体测量和CT测量。测量指标包括后结节高度、后弓的宽度、从理想人钉点到椎动脉沟内缘的距离、人钉点到后结节的距离及理想的钉道角度，比较两种方法测量结果的统计学差异。再对100张寰椎三维CT片进行测量，测量指标有后结节（后弓中点矢状面垂直距离）高度、后弓的宽度（水平面后弓与椎动脉沟移行处内侧）、从理想入钉点到椎动脉沟内缘（螺钉完全位于髓腔内）的距离、理想人钉点到后结节的距离及理想钉道的角度（理想钉道与水平线夹角），分析寰椎的解剖学特点。计算后结节高度〉7mm，后弓宽度〉3．5mm及无法对侧置钉的比例。结果寰椎标本的实体测量和CT测量的结果差异无统计学意义。100张寰椎三维CT经测量，椎板后弓的宽度：左侧为（4．7±O．9）mm，右侧为（4．6±0．8）mm；93．5％（187／200）宽度〉3．5mm。从理想的入钉点到椎动脉沟内侧缘的髓腔距离（理想螺钉长度）：左侧为（15．9±3．0）mm，右侧为（15．9±3．0）mm，提示螺钉的长度可超过15mm。后结节的高度值为（7．8±1．2）mm，91％（91／100）高度〉7mm。理想钉道的角度：左侧为26．8°±6．8°（8°-44°），右侧为26．8°±6．3°（13°-44°），11％（22／200）无法交叉置钉。结论解剖学和影像学研究提示寰椎后弓交叉螺钉技术是安全有效的固定方法，为寰椎后路固定提供选择。
Objective To identify the anatomical feasibility of cross screw fixation in the atlas via posterior arch, provide a reference for clinical applications. Methods A total of 10 dry atlas specimens were used to measure anatomic data and three dimension（3D） CT data. The data included height of the poste- rior tubercle, width of the posterior arch, distance from the ideal point to the interior of the vertebral artery sulcus, from nail point to central line, and the ideal direction of the screws. Statistical analysis was done to compare the two methods. Then 100 3D CT data were measured. The parameters included height of the pos- terior tubercle （mid-sagittal plane）, width of the posterior arch （the inner side where arch transformed to the vertebral artery sulcus）, distance from the ideal point to the interior of the vertebral artery sulcus （where screws completely located in the medullary cavity）, distance between the nail point to central line, and angle of the ideal screws （between screws and horizontal line）. The anatomy of the atlas was analyzed for whether height of the posterior tubercle is more than 7 mm, width of the posterior arch is more than 3.5 mm, and whether or not cross screws can be planted. Results There was no statistical difference between anatomic and 3D-CT measures. Thickness of the C1 laminar was （4.7±0.9） mm in the left side, （4.6±0.8） mm in the right side, and 93.5% of specimens were thicker than 3.5 mm. Distance of the ＂ideal screw＂ was （15.9±3.0） mm in the left side, （15.9±3.0） mm in the right side. Height of the Cl posterior tuber was （7.8±1.2） mm, with 91% of the data higher than 7.0 mm. Angle between the axial of CI laminar and frontal plane was 26.8°±6.8° （8°-44°） in the left side, 26.8°±6.3°（13°-44°） in the right side, and about 11% of them can not cross plant. Conclusion It is feasible and safe to place cross screws in the posterior arch of the C1 in anatomy.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第1期65-69,共5页
Chinese Journal of Orthopaedics
关键词
寰椎
骨螺丝
骨折固定术
内
解剖学
Atlas
Bone screws
Fracture fixation, internal
Anatomy
