内镜引导经后路第三和四颈椎椎弓根螺钉内固定的解剖学研究  

Anatomical research on endoscope-guided screw internal fixation through PLIF C_(2-3) pedicle

作　　者：曾铁功[1] 易德保[2] 罗特坚[2] 

机构地区：[1]邵阳医学高等专科学校外科学教研室,湖南邵阳422000 [2]邵阳医学高等专科学校人体解剖学教研室

出　　处：《解剖学研究》2010年第5期349-350,364,共3页Anatomy Research

基　　金：湖南省科技计划项目(2008-SK-3029)

摘　　要：目的研究颈后区的应用解剖,为临床内镜引导经后路第2、3颈椎(C2-3)椎弓根螺钉内固定术提供解剖学资料。方法选择教学用的成人尸体进行头颈部血管铸型;颈后区局部解剖;施行内镜引导经后路C2-3椎弓根螺钉内固定模拟手术。观察颈后区的血管构筑、脊神经后支的分布及其相互关系;经X线摄片观察。结果颈后区在后正中线外侧6.2mm以外椎外静脉丛吻合丰富;颈深动脉在后正中线5.5mm上行;椎动脉经C1横突孔穿出处距后正中线34.1mm;第1、2颈神经后支穿出部位距后正中线分别为11.5、32.1mm。结论临床内镜引导经后路C2-3椎弓根螺钉内固定术,内镜置入部宜选用在C2棘突水平距后正中线5mm处,螺钉进入点可选定在C2-3侧块距其外侧缘5mm,距下关节突下缘8mm处,螺钉进入的延长线与正中矢状切面的夹角应为40°～45°之间,并向头侧倾斜10°为宜,螺钉的长度为24～30mm,￠为5mm为佳,内镜引导经后路C2椎弓根螺钉内固定模拟手术获得满意效果。Objective To study practical anatomy in region colli posterior and provide anatomical materials for endoscope-guided screw internal fixation through PLIF C2-3 pedicle.Methods Select the adult bodies used as teaching and casting the head and neck blood vessels,locally dissect the region colli posterior and do endoscope guided screw fixation simulation operations through PLIF C2-3 pedicle.Observing the construction of blood vessels,distribution of ramus posterior nervorum spinalium and their correlations in region colli posterior and observing the images through X-ray Photographs.Results The external vertebral venous plexus anastomosed abundantly at 6.2mm lateral of posterior median line in region colli posterior,the deep cervical artery went up in the place of 5.5mm from posterior median line,the vertebral artery crossed through C1 cervical foramina which was 34.1 mm away from linea mediana posterior and the first and second rami posteriores nervorum cervicalium were 11.5 mm and 32.1 mm apart from linea mediana posterior respectively.Conclusion Regarding the clinical endoscope guided screw fixation through PLIF C2-3 pedicle,we should choose C2 spinous process as the place which is 5 mm from linea mediana posterior for the endoscope posting position and choose the place of C2-3 lateral mass which is 5mm from its margo lateralis and 8mm from inferior auricular process margo inferior as the bolt posting point.The intersection angle of extension line of bolt posting and middle sagittal section should be between 40 and 50 degree and it is optimum for 10 degree leaning against side of head.Meanwhile the length of bolt should be 24-30 mm and is 5 mm.Finally,it could achieve satisfactory effect through this simulated operation

关 键 词：内镜引导 经后路 上颈椎 螺钉内固定 应用解剖 

分 类 号：R687.3[医药卫生—骨科学]