螺旋CT多平面重建对寰枢椎改良后路经关节螺钉内固定的意义  

Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation

作　　者：徐峰[1] 周跃[1] 陈庄洪[2] 

机构地区：[1]第三军医大学附属新桥医院骨科,重庆400037 [2]广州军区武汉总医院骨科

出　　处：《临床外科杂志》2008年第11期771-773,共3页Journal of Clinical Surgery

摘　　要：目的通过对正常人螺旋CT多平面重建检查,并对其行后路经关节螺钉内固定技术相关形态学参数的测量,为临床提供患者个体化手术相关信息。方法对60例正常人进行寰椎的螺旋CT检查,获取相关参数并进行分析。采用枢椎下关节突正中为进钉点模拟寰枢椎后路经关节螺钉内固定术,在螺旋CT重建上获得轴面和矢状面的正确倾斜角度。C2峡部高度和宽度,理想的螺钉长度,理想的螺钉矢状面和轴面倾斜度,以及理想的螺钉路径与椎动脉沟之间距离。结果C2峡部高度为(8.02±1.92)mm,峡部宽度(6.05±1.32)mm,理想的螺钉长度为(41.22±4.48)mm,螺钉矢状面倾斜度为53.87°±5.61°,与内向成角(14.81°±2.81°)。10侧(8%)峡部狭窄(宽度或高度小于5mm),测量其椎动脉沟与理想螺钉途径之间距离,有12例(10%)小于2.5mm,因此总共有22侧(18%)存在潜在椎动脉损伤风险。结论术前对每个患者行CT检查十分必要,能充分地了解个体的解剖结构,提高手术的安全性。Objective To determine atlanto- axial bone morphometrie measurements related to screw transarticular fixation technique in order to provide operation relative information for the patients. Methods Sixty helical computerized tomography （helical CT ） scans with volumetric acquisition, including the first and the second cervical vertebrae were studied. The screw insertion at the center of the inferior articular process of the axis for C1 - C2 posterior transarticular fixation and the correct oblique axial and oblique parasagittal planes were obtained with muhiplanar reconstruction （MPR） on helical CT. The measured parameters on each side of the vertebrae were C2 interarticular isthmus height and width, optimal screw length, optimal screw trajectory sagittal and axial angles, and the distance between the ideal screw trajectory and the vertebral artery groove. Results C2 interarticular isthmus height measured was 8.02 ± 1.92 ram, C2 interarticular isthmus width 6.05 ± 1.32 mm, optimal screw length 41.22 ± 4.48 mm, optimal screw trajectory sagittal angle 53.87°± 5.61°,optimal screw trajectory medial angle 14.81 ± 2.81°. Isthmus narrowing under 5 mm（ height and/or width） was seen in 10 cases （8%）. In 35 cases （30%） reconstructed parasagittal images showed the vertebral artery groove. In those cases, the distance between the vertebral artery groove and the ideal screw path was measured. This distance measured was less than 2.5 mm in 10% （ 12 cases） of C2 articular masses, involved 4 cases of isthmus narrowing in these 12 cases. Therefore, 22 cases （ 18% ） of patients had potential risk for the vertebral artery in this operation. Conclusions Preoperative CT scans are very important to obtain the individual anatomical structure thoroughly, and to raise the safety of the operation.

关 键 词：寰枢关节 经关节螺钉内固定 螺旋CT 上颈椎 

分 类 号：R687.3[医药卫生—骨科学] R816.8[医药卫生—外科学]