后路寰枢椎椎弓根螺钉内固定的术前计划  

Preoperative Planning of the Posyerior Atlantoaxial Pedicle Screw Fixation

作　　者：林达强[1] 李俊峰[2] 陈兴爱 谭显春[1] 李鑫[2] 严吉平 王清[3] 

机构地区：[1]达州市第二人民医院骨科,四川达州635000 [2]达州市第二人民医院CT室,四川达州635000 [3]泸州医学院附属医院骨科

出　　处：《华西医学》2009年第4期831-834,共4页West China Medical Journal

摘　　要：目的:探讨后路寰枢椎椎弓根螺钉内固定的术前计划方案,明确其手术指导意义。方法:选取经CT评估寰枢椎椎弓根螺钉置入可行的,并拟选择该手术治疗的上颈椎不稳患者15例,容积再现重建(VR)寰枢椎椎弓表面影像,了解个体椎弓后方表面解剖形态与骨性解剖标志。同时按寰枢椎椎弓根理想的钉道走行,多平面重建(MPR)个体椎弓根断面影像。术前根据这些解剖影像设计手术暴露路经、理想的进钉点与钉道轨迹。术中按该术前计划手术暴露,找到理想的进钉点并钻孔置椎弓根螺钉。将术中观察到的C1后弓及C2椎弓表面解剖,与术前CT重建影像对比。术后CT复查,评价螺钉置入情况。结果:15例术中观察到的C1后弓及C2椎弓表面解剖特征与术前CT容积再现的影像一致。参照寰枢椎椎弓CT影像解剖制定术前计划方案,术中按其逐一操作,手术简单、直观,无重要血管神经损伤,置钉准确。结论:根据CT容积再现与多平面重建的寰枢椎解剖影像,制定后路寰枢椎椎弓根螺钉内固定术前计划方案,指导手术安全、可靠。Objective.. To explore the clinical significance of preoperative planning in posterior atlantoaxial pedicle screw fixation. Methods： Fifteen cases who sustained fresh fracture of odontiod process and/or pedicle underwent up-per cervical multi-slice spiral CT, which were considered advisable for posterior atlantoaxial pedicle screw fixation. And then 3D images of C1-C2 vertebral arch surface and optimal pedicle screw cross section were reconstructed with volume reconstruction （VR） and multi-plane reconstruction （MPR） techniques respectively. The reconstructed 3D im- ages were then utilized to plan the operating procedures and plot pedicle optimal screw trajectories, so that the operative schemes were determined. 15 patients operating fields were exposed and screws were placed into the previously created holes by anatomic landmarks according to the presurgically planning. And the anatomical morphology of C1 posterior arch and C2 arch was compared with preoperative VR images. Also, the patients were followed up by CT reconstruction to estimate the screw actual positions. Results：The intraoperative anatomical morphology of C1 posterior arch and C2 arch was consistent with preoperative VR images. The preoperative information of anatomical structures and bony anatomic landmarks could be used for surgeons to expose operating field and to ensure the comfortable point for screw positions. There isn＇t the risk of screw misplacement and vertebral artery injury. Conclusion： With MPR and VR images, it＇s safe and effective to direct operation by individual preoperative planning of dorsal atlantoaxial pedicle screw fixation.

关 键 词：寰枢椎 解剖 椎弓根螺钉 内固定 术前计划 

分 类 号：R687.1[医药卫生—骨科学]