颈椎单开门OsteoMed M3钉板内固定椎管扩大成形术螺钉进钉点的解剖学CT测量  

CT measurement of the anatomical entry point of screws on expansive unilateral open-door laminoplasty of the cervical spine with OsteoMed M3 plate and screws

作　　者：胡孔和[1] 吴强[1] 靳安民[2] 段扬[2] 席新华[1] 包拥政[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院骨科,广东韶关512026 [2]南方医科大学附属珠江医院骨科,广州510282

出　　处：《中国矫形外科杂志》2012年第24期2272-2275,共4页Orthopedic Journal of China

基　　金：广东省科技计划项目(编号:2011B031300027)

摘　　要：[目的]探讨OsteoMed M3钉板系统在颈椎单开门椎管扩大成形术中应用时在椎板侧拧入5 mm长螺钉的进钉点及损伤脊髓神经及血管的风险。[方法]随机调出无明显颈椎疾患的患者CT资料100份,其中男50份,年龄20～86岁,平均51.32岁;女50份,年龄17～74岁,平均43.54岁。通过HIS及PACS系统测量CT资料上螺钉进钉点至椎管内的垂直最短距离、距离横突孔的最短距离以及距离神经根通道的最短距离。[结果]男女C3～6侧块内侧缘至侧块中点之间距离横突孔最短距离的95%正常参考值下限及C3～7侧块内侧缘至侧块中点之间距离神经根通道最短距离的95%正常参考值下限均大于在颈椎单开门术中所使用的OsteoMed M3钉板内固定系统中的螺钉长度5 mm;而男女C3～7椎板外侧缘与侧块内侧缘交界处至椎管内垂直最短距离的95%正常参考值下限部分小于在颈椎单开门术中所使用的OsteoMed M3钉板内固定系统中的螺钉长度5 mm,尤其对女性。[结论]在颈后路行单开门OsteoMed M3钉板内固定时螺钉固定在侧块内侧缘至侧块中点之间是安全的,螺钉的进钉稍偏向外上方不会损伤血管神经及脊髓。[ Objective] To evaluate the method that OsteoMed M3 titanium plate and screws were used to secure the posterior elements in the open position after expansive unilateral open-door laminoplasty and to evaluate the risk of damaging spinal cord, nerve and vertebral artery due to screws of 5mm length. [ Method] The CT scans of 100 patients without cervical spine dis- ease were random extracted, and there were 50 males with mean age of 51.32 years （ aged 20 - 86 years）, and 50 females with mean age of 43.54 years （ aged 17 - 74 years）. The anatomic data of cervical vertebrae in each group were measured and recor- ded using computerized image analysis software of HIS and PACS system. Measure indexes on CT were as follows：the vertical shortest distance between the entry point of screws and spinal canal, and the shortest distance between the entry point of screws and transverse foramen, and the shortest distance between the entry point of screws and nerve root port. [ Result] The 95 % nor- mal lower limit of the shortest distance between junction of the lamina lateral margins of C3 - C6 with the lateral mass medial margins of C3 -C6 and transverse foramen were all greater than the length of 5 mm screw,and the 95% normal lower limit of shortest distance between junction of the lamina lateral margins of C3 - C7 with the lateral mass medial margins of Ca - C7 and nerve root port were all greater than the length of 5 mm screw. The 95% normal lower limit of vertical shortest distance between junction of the lamina lateral margins of C3 - C7 with the lateral mass medial margins of C3 - C7 and spinal canal were part less than the length of 5 mm screw, especially in female patients. [ Conclusion ] The results demonstrated that it was safer that the en- try point of screws lied in the site among the lateral mass lateral margins and the lateral mass medial margins, and the risk of neural injury, spinal cord injury and vertebral artery injury could not occur.

关 键 词：椎管扩大成形 内固定 CT 测量 

分 类 号：R687.3[医药卫生—骨科学]