后路经关节螺钉内固定相关解剖的螺旋CT多平面重建测量  

Measurement of Anatomy Related to Planning of Atlanto-axial Posterior Transarticular Screw Fixation by Multiplanar Reconstructions of Helical Computed Tomography

作　　者：徐峰[1] 周跃[1] 陈庄洪[2] 

机构地区：[1]重庆市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,湖北武汉430070

出　　处：《中国临床神经外科杂志》2008年第11期651-654,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的通过对正常人寰枢椎的螺旋CT多平面重建检查,对其行后路经关节螺钉内固定术(Magerl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例正常人进行寰枢椎的螺旋CT检查,在获取的多平面CT重建图像上按照Magerl术模拟手术。并对颈椎双侧C2峡部高度和宽度、理想的螺钉长度、理想的螺钉上倾角及内倾角,以及理想的螺钉路径与椎动脉沟之间距离进行测量。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(37.22±3.08)mm,螺钉上倾角为(50.18±4.25)°,内倾角(8.31±2.52)°。10侧(8.3%)峡部狭窄(宽度或高度小于5mm);35侧(29.2%)矢状面重建图像可见到椎动脉沟,其中16侧(13.3%)椎动脉沟与理想螺钉途径之间距离小于2.5mm。这12侧中也包含了4例峡部狭窄的患者,因此总共有22侧(18.3%)存在解剖变异,其行Magerl术时有损伤椎动脉风险。结论行后路经关节螺钉固定术前对每个患者行寰枢椎CT检查十分重要,能充分的了解其解剖结构的个体差异,可提高手术的安全性。Objective To explore the atlanto-axial bone morphology and its abnormality related to transarticular screw fixation （Magerl operation） by helical computed tomography （CT） muhiplanar reconstruction in order to provide the information for the individual operation. Methods Helical CT examination of atlanto-axial vertebrae and multiplanar reconstructions were performed in 60 normal subjects including 40 men and 20 women. Magerl operation was simulated on muhiplanar reconstruction imagings of helical CT. C2 interarticular isthmus height and width, optimal screw length, angles between optimal screw trajectory and sagittal or axial direction, and the distance between the optimal screw trajectory and the vertebral artery groove on both the sides of cervical vertebrae were measured in all the subjects. Results C2 interarticular isthmus height and width were （8.02±1.92）mm and （6.05±1.32）mm respectively. The optimal screw length was （37.22±3.08）mm. The optimal angles between the screw trajectory and sagittal direction and between the screw trajectory and axial direction were （50.18±4.25）° and （8.31±2.52）° respectively. The isthmus were narrow （height and/or width 〈5 mm） in 10 sides （8.3%）. The reconstructed parasagittal images showed the vertebral artery groove in 35 sides of cervical vertebrae. In those sides, the distances between the vertebral artery groove and the optimal screw trajectory were shorter than 2.5 mm in 16 sides （13.3%） of C2 articular masses, including 4 sides of the narrow isthmuses. Therefore there was risk of damage to the vertebral arteries by Magerl operation in 22 sides of C2 articular masses where there was anatomical abnormality. Conclusions Preoperative CT scans are very important to obtaining the individual abnormality of atlanto-axial vertebrae and to the safety of Magerl 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：R322.71[医药卫生—人体解剖和组织胚胎学] R322.72[医药卫生—基础医学]