CT测量在经口咽前路寰枢椎复位钢板内固定手术的作用  

The effect of pre-operative CT measurement in guiding of the usage of transoral atlantoaxial reduction plate

作　　者：艾福志[1] 尹庆水[1] 徐达传[2] 夏虹[1] 吴增晖[1] 昌耘冰[1] 权日[1] 章凯[1] 麦小红[1] 刘景发[1] 

机构地区：[1]广州军区广州总医院骨科,广州市510010 [2]南方医科大学临床解剖学研究所,广州市510515

出　　处：《中国脊柱脊髓杂志》2007年第12期904-907,共4页Chinese Journal of Spine and Spinal Cord

基　　金：广东省自然科学基金团队项目(20023001);广东省医学科研基金项目(A2005500);广东省科技计划项目(2004B34001012)

摘　　要：目的:探讨术前CT测量在经口咽入路改良Ⅱ代解剖型寰枢椎复位钢板(TARP)内固定手术中的作用。方法:15例难复性寰枢椎脱位患者均采用Ⅱ代解剖型TARP内固定手术,术前行寰枢椎薄层CT扫描及三维重建,测量与TARP内固定的相关指标,并应用测量数据指导手术实施。结果:术前CT测量寰椎钉道长度为18.7±1.3(16.2～21.1)mm,枢椎钉道长度为14.7±0.9(12.8～15.6)mm,寰椎进钉外偏角为12.2°±0.4°(10.2°～14.6°),枢椎进钉内偏角为7.3°±0.3°(5.1°￣9.4°),寰椎向外侧显露不能超过寰椎侧块外缘至前结节的距离为22.4±2.1(18.6～25.6)mm,根据寰椎进钉点间距和寰枢进钉点的垂直间距确定钢板型号,所有钢板成功安置,术后影像学检查均证实术前测量基本准确。结论:术前薄层CT扫描及三维重建测量对Ⅱ代解剖型TARP手术复位固定有很强的指导作用。Objective：To investigate the role of pre-operative CT measurement in guiding of using the modified second generation transoral atlantoaxial reduction plate （TARP-Ⅱ ） in the surgery of atlantoaxial dislocation.Method：Fifteen patients with irreducible atlantoaxial dislocation were studied.The thin-slice CT scanning and the three-dimension reconstruction were performed pre-operation.The data related to TARP internal fixation was measured and applied to the guidance of the operation.Result：According to the preoperative CT measurement,the length of C1 screw tunnel was 18.7±1.3（16.2-21.1）mm.The length of C2 screw tunnel was 14.7±0.9 （12.8-15.6）mm.The screw entry angle at C1 was 12.2°±0.4°（10.2°14.6°） laterally and that at C2 was 7.3°±0.3°（5.1°- 9.4°） medially.The distance exposed laterally at C1 could not exceed 22.4± 2.1 （18.6-25.6）mm,whieh represented the distance between the external border of lateral mass and the anterior tubercle.The size of the plate could be decided by the distance between the two screw entry points of C1 and the vertical distance between the entry points of C1 and C2.The CT measurement results were verified to be accurate by the operation and the post-operative imaging examination.Conclusion：The preoperative measurement of thin-slice CT scanning and three-dimension reconstruction is very important and meaningful in guiding the usage of TARP-Ⅱ in the surgery of atlantoaxial dislocation.

关 键 词：寰枢关节 内固定器 影像学 

分 类 号：R683.2[医药卫生—骨科学] R814.42[医药卫生—外科学]