颈椎弓根毗邻神经解剖结构观察及置钉相关性研究  

Anatomic study on relationship between cervical pedicle and adjacent neural structure

作　　者：郭晓东 张建湘[2] 

机构地区：[1]内蒙古自治区人民医院骨科,呼和浩特010017 [2]安徽医科大学附属医院骨科,合肥230030

出　　处：《中国骨与关节外科》2013年第2期173-176,181,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:由于颈椎弓根螺钉独特的三维稳定性和高风险性,临床工作需要更完善的解剖学研究。目的:测量颈椎弓根和毗邻结构之间的量化关系值,为在颈椎弓根内安全置钉提供帮助,以减少并发症。方法:在15具经福尔马林防腐处理的尸体上,去除颈椎棘突,椎板,相关韧带及侧块,上、下关节突,暴露出颈椎弓根的狭窄部及毗邻的神经组织。直接测量椎弓根内壁与硬膜囊的距离(PDSD)、椎弓根狭窄部内壁间的距离(IPD)以及该节段硬膜囊横径(DSW)。结果:15具标本中,PDSD:0～6.2mm,IPD:21.0～25.4mm,DSW:13.5～18.3mm。男女之间有差异。并图示了硬膜外静脉丛与椎弓根的关系。结论:大多数情况下,颈椎弓根与毗邻的神经结构之间存在一定的距离。向颈椎弓根的内、上方置入椎弓根螺钉是相对安全的。Background： Considering the unique three dimensional structure and high risks of cervical pedicle screws, we need detailed anatomic research on cervical vertebrae. Objective： To measure accurate anatomic distances between the cervical vertebrae and adjacent neural structure so as to avoid and minimize complications of pedicle screw implantation. Methods： Fifteen cadavers were used for dissection to observe the relationship between the cervical spine and adjacent neural structure. After removal of whole posterior bony element of the cervical spine, the isthmus of the pedicles, the nerve roots of C3-C7 and the dural sac were exposed. Pedicle-dural sac distance （PDSD）, interpedicular distance （IPD）, and dural sac width （DSW） were measured directly. Results： In 15 cadavers, PDSD, IPD and DSW were 0-6.2 mm, 21.0-25.4 mm and 13.5-18.3mm, respectively. There was significant difference in above indice between men and women. The relationship between the epidural venous plexus and cervical pedicle was explained. Conclusions： There is some space between the cervical pedicle and its adjacent neural structure in common. It seems safe to place the pedicle screw in the cervical pedicles inward and upward.

关 键 词：解剖 颈椎弓根 椎弓根螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]