前路经枕寰枢关节螺钉内固定术的可行性及安全性研究  

Feasibility and safety of anterior transarticular screw fixation from axis to occiput

作　　者：蔡贤华[1] 李明[2] 黄卫兵[1] 曾晓华[3] 谭惠斌[3] 郑宇[1] 张中[2] 李世梁[1] 

机构地区：[1]广州军区武汉总医院骨科,武汉430070 [2]南方医科大学研究生学院 [3]广州军区武汉总医院放射科,武汉430070

出　　处：《中华创伤骨科杂志》2012年第3期188-192,共5页Chinese Journal of Orthopaedic Trauma

基　　金：全军医学科学研究“十一五”计划攻关课题（08G031）

摘　　要：目的通过影像学方法探讨前路经枕寰枢关节螺钉内固定术的可行性和安全性。方法随机选取30例健康成人头颈部CT血管造影检查资料，男18例，女12例；年龄21。55岁，平均33．6岁。利用Vitreal 4．0软件测量理想钉道角度、长度及其与椎动脉的距离。在此基础上，对2具防腐枕颈部标本进行模拟手术，行x线及CT检查以明确螺钉位置。结果从人钉点平面至锚定点平面椎动脉在形态上有5个恒定的生理弯曲；入钉点平面处两侧椎动脉间距为（25．59±1．04）mm；螺钉内固定理想钉道角度：冠状面上外倾角为18．62°±2．17°，矢状面上后倾角为24．35°±3．02°；理想钉道长度为（35．95±2．16）mm。理想钉道与椎动脉的关系于寰椎横突孔上方椎动脉弯曲平面最为密切，其距离为（3．66±0．55）mm。模拟手术的影像学检查证实钉道角度、长度均位于参考值范围内，无穿出骨质及进入舌下神经管者。结论国人采用前路经枕寰枢关节螺钉内固定在解剖上是可行的，钉道与椎动脉之间有一定的安全距离，但术中必须严格控制钉道方向。Objective To investigate the feasibility and safety of anterior transarticular screw fixation from axis to occiput. Methods The data of head-neck CT angiography for 30 healthy adults were used in the present study. The angle, length and distance to the vertebral artery of the ideal screw trajectory were measured with the software Vitreal 4.0. According to the measurements, anterior transarticular screw fixation from axis to oceiput was performed on 2 embalmed eraniovertebral junction specimens. Three-dimensional CT reconstruction was performed postoperatively to study positions of the screws. Results The vertebral artery had 5 physiologic curves between the entrance point plane and the anchor point plane. The distance between bilateral vertebral arteries was 25.59 ± 1.04 mm on the entrance point plane. The angle of the screw ideally placed was 18.62 ＋2. 17 degrees laterally on the coronal plane and 24.35 ± 3.02 degrees posteriorly on the sagittal plane. The mean length of the ideal screw trajectory was 35.95± 2. 16 mm. The shortest distance between the vertebral artery and the screw trajectory was at the topmost point of the vertebral artery groove over the transverse foramen of atlas on CT images, with an interval of 3.66 ± 0. 55 mm. Imageological examination of the simulated surgery demonstrated that the angle and length of the ideal screw trajectory were within the reference range, without piercing the bone or protruding into the hypoglossal canal. Conclusions The technique of anterior transarticular screw fixation from axis to occiput is feasible in normal Chinese, for there is a safe distance between the vertebral artery and the screw trajectory. However, the direction of screw emplacement should be rigorously controlled.

关 键 词：骨钉 颈椎 骨折固定术 内 成像 三维 

分 类 号：R687.3[医药卫生—骨科学]