基于CT三维成像的经皮前路寰枢椎关节螺钉内固定相关解剖学研究  

ANATOMIC STUDY ON PERCUTANEOUS ANTERIOR TRANSARTICULAR SCREW FIXATION BY CT THREE-DIMENSIONAL IMAGING

作　　者：陆焱[1] 王建[1] 刘杰[1] 潘文琦[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《中国修复重建外科杂志》2011年第12期1445-1448,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的测量经皮前路寰枢椎关节螺钉内固定(percutaneous anterior transarticular screw fixation,PATSF)相关参数,为提高PATSF的安全性提供参考依据。方法对50例成人志愿者进行寰枢椎螺旋CT扫描三维重建,获取经寰椎上关节面内侧缘横断面、枢椎椎动脉沟冠状面和寰枢椎正中矢状面,观察寰枢椎骨性结构、椎动脉沟的走行,通过测量和计算得出PATSF植钉位置、植钉角度、植钉长度及容许寰椎侧块分离情况的相关参数并进行分析。结果 PATSF植钉位置为枢椎椎体前下缘中点旁开4.0 mm较适宜,植钉最大外偏角度为(29.89±1.41)°,最小外偏角度为(4.37±0.87)°,最大后倾角度为(32.41±1.66)°,优化外偏角度为(17.13±0.88)°,优化后倾角度为(17.62±1.03)°,优化植钉长度为(41.57±0.79)mm。寰枢椎侧方关节面横径为(16.71±1.61)mm,容许寰椎侧块分离移位最大距离为(6.96±1.09)mm,占寰枢椎侧方关节面横径百分比为41.80%±5.69%。结论 PATSF优化植钉法安全可靠;寰椎侧块分离移位程度在一定范围内,仍允许关节螺钉植入。Objective To improve the safety of the percutaneous anterior transarticular screw fixation（PATSF） by measuring the parameters related to PATSF.Methods Spiral CT scan and three-dimensional reconstructions of the atlantoaxis were performed in 50 adult volunteers.The section of inner margin of atlantal superior articular facet,the coronal plane of vertebral artery cavity,and the sagittal plane of atlano-axis were obtained with multiplanar reconstruction on helical CT.The atlantoaxial vertebral structure and the direction of vertebral artery cavity were observed.The parameters related to PATSF were measured and analysed.Results The suitable position of screw insertion was 4.0 mm from the midpoint of the axoidean anteroinferior margin.The maximum external angle of PATSF was（29.89 ± 1.41）°;the minimum external angle was（4.37±0.87）°;the maximum backward angle was（32.41 ± 1.66）°;the optimal external angle was（17.13 ± 0.88）°;the optimal backward angle was（17.62 ± 1.03）°;and the optimal screw length was（41.57±0.79） mm.The atlantoaxial articular facial diameter was（16.71 ± 1.61） mm;the maximum distance of atlantal lateral displacement was（6.96 ± 1.09） mm;and the ratio of them was 41.80% ± 5.69%.Conclusion The optimal insertion of PATSF is safe and reliable.The screw can be inserted when the displacement of the atlantal lateral mass is in a certain degree.

关 键 词：寰枢椎 经皮前路寰枢椎关节螺钉内固定 关节不稳定 CT三维重建 

分 类 号：R687.3[医药卫生—骨科学]