下颈椎经关节螺钉固定“两点法”置钉的解剖学研究  

Anatomical study of lower cervical transarticular screw fixation by two-point method

作　　者：孙韶华[1] 刘观燚[1] 徐荣明[1] 马维虎[1] 胡勇[1] 

机构地区：[1]宁波市第六医院骨科,浙江315040

出　　处：《脊柱外科杂志》2009年第5期289-292,297,共5页Journal of Spinal Surgery

摘　　要：目的通过解剖学研究,获得下颈椎经关节螺钉的安全置钉方法。方法取18具颈椎标本,仔细解剖颈部的后方和前侧方,以清楚地暴露颈椎侧块,保护好脊神经前、后支(C2～8)及与周围结构的关系。确定安全进、出钉:以侧块背面中心点内侧1mm为进钉点;下位椎体上关节突的侧前方,横突与关节突相交处为出钉点。从C2/C3～C5/C6直视下通过以上2点置入克氏针,通过正侧位X线片测量克氏针在矢状面上的尾倾角、在冠状面上的外倾角及进钉深度,以确定经关节螺钉固定的进钉角度和螺钉长度,并测量经关节螺钉出钉点与脊神经前、后支和椎动脉的距离。结果实验中所有克氏针均成功置入。经关节螺钉的外倾角度为16.5°±5.1°,尾倾角度为36.6°±5.1°,钉道长度为19.0mm±1.2mm。经关节螺钉的外倾角度和尾倾角度在各节段间略有不同,但差异均无统计学意义(P>0.05),但钉道长度在C2/C3与C3/C4/C5/C6间差异有统计学意义(P<0.05)。经关节螺钉出钉点与脊神经前支距离为18.2mm±2.3mm,与后支距离为7.3mm±1.4mm,与椎动脉距离为5.8mm±1.5mm,在各节段间略有不同,但差异均无统计学意义(P>0.05)。结论使用下颈椎经关节螺钉固定技术时建议以侧块背侧中心点内侧1mm为进钉点,在矢状面上尾倾35°～40°,在冠状面上外倾15°～20°,尽量将螺钉从下位椎体上关节突的侧前方、横突后嵴与关节突连接处出钉。Objective To provide anatomical data for cervical transarticular screw implantation by two-point method according to a cadaveric study.Methods Eighteen cervical cadaveric specimens were dissected with care taken to expose the lateral mass and preserve the ventral and dorsal ramus of the nerve roots（C2-8） and their anatomic relationships to surrounding structures.The safe entry point for the transarticular screws was determined to be 1 mm medial to the center of lateral mass on its back side.The ideal exit point of the drill was determined to be the juncture between the transverse process and the facet,lateral-anterior to the superior articular process of the vertebral body below.Posterior transarticular K-pin implantation was performed under visual control to connect the 2 points from C2/C3 to C5/C6.The angles of K-pin trajectory including caudal angulations on the sagittal plane and lateral angulations on the coronal plane as well as the implanted depth were measured on positive and lateral X-rays in order to confirm the angles and lengths of transarticular screws trajectory.The distance from the exit point to the ventral and dorsal ramus and the vertebral artery were also measured.Results Transarticular K-pin implantation was successful in all the cases.The angles of the screws were 36.6°±5.1° caudal tilting and 16.5°±5.1° lateral tilting.The caudal and lateral angulations had a few differences at different levels of vertebral spine,but there was no statistic significance（P〉0.05）.The lengths of transarticular screws trajectory was 19.0 mm±1.2 mm,and there was some difference between C2/C3 and C3/C4/C5/C6（P〈0.05）.The distances from the exit point to the ventral and dorsal ramus and the vertebral artery were 18.2 mm±2.3 mm,7.3 mm±1.4 mm,and 5.8 mm±1.5 mm,respectively,and there were a few difference at different levels of vertebral spine,but without statistic significance（P〉0.05）.Conclusion The safe screw trajectory is determined to be 35°～40° caudal tilting on the sagittal plan

关 键 词：颈椎 椎关节突关节 内固定器 解剖学 

分 类 号：R681.531[医药卫生—骨科学]