枕骨髁螺钉进钉点的解剖学研究  

An applied anatomic study of investigating the inserting position that placement of screws in the Chinese occipital condyle

作　　者：余作冲[1] 姜建元[2] 金翔[2] 吕飞舟[2] 马晓生[2] 王立勋[2] 夏新雷[2] 王洪立[2] 

机构地区：[1]复旦大学附属金山医院,上海201508 [2]复旦大学附属华山医院

出　　处：《中华骨科杂志》2013年第11期1115-1119,共5页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目（81071438）;上海市科委重点攻关项目（10441902200）;2010上海市卫生局重点项目

摘　　要：目的采用应用解剖学研究结合影像学研究，探讨国人枕骨髁螺钉进钉点的最佳位置参数。方法随机选用20个新鲜尸体头颅标本，先行CT平扫及二维重建，排除枕颈区破坏或畸形的标本。在CT图像上使用4．0mm粗的虚拟线模拟置钉过程，以矢状位最大长度为标准选取进钉点，测量进钉点至枕骨髁内侧缘的水平距离和进钉点至颅底的垂直距离。根据测量结果确定枕骨髁螺钉进钉点的位置，切除部分寰椎后弓，置入直径4．0mm的螺钉，再通过枕骨髁解剖、椎动脉充盈试验及CT扫描，确认枕骨髁螺钉置钉的成功率和安全性。结果20个新鲜尸体头颅标本均通过CT筛检，总计得到40侧枕骨髁。进钉点至枕骨髁内侧缘的水平距离左侧为（7．6±0．9）mm，右侧为（7．3±0．6）mm，双侧比较差异无统计学意义；进钉点至颅底的垂直距离左侧为（10．2±1．6）mm，右侧为（9．9±1．0）mm，双侧比较差异无统计学意义。根据CT测量的进钉点位置，36个枕骨髁成功置入螺钉，经解剖及CT扫描证实无舌下神经管损伤，螺钉未穿出枕骨髁内、外侧壁，未损伤椎动脉；4个枕骨髁在置钉时分别穿破内侧壁。结论通过CT重建技术选择正确的进钉点能够使枕骨髁螺钉置入获得最大长度地，尽可能地减少枕骨髁螺钉置入的风险。左、右侧枕骨髁进钉点位置选择的差异无统计学意义。置钉时部分寰椎后弓的切除能够有效地避免椎动脉的损伤。Objective To investigate the choice of screw placement in the Chinese occipital condyle using applied anatomy and imaging. Methods Twenty heads of fresh cadavers were chosen for the study. First, computerized tomography （CT） scanning and two-dimensional （2D） reconstruction were performed on these heads, aiming to exclude the heads with destroyed or deformed occipital condyle. In the CT imaging, 4.0 mm virtual lines were used to simulate the process of inserting screws. Using the longest diameter of the head in sagittal plane as the standard, the position of inserting screws was chosen, and the horizontal distance between the position of inserting screws and the margin medialis of the occipital condyle, and the vertical distance be- tween the position of inserting screws and the basis crania were measured. Based on the result of measurements, the position of inserting screws was determined. After removal of partially posterior arch of the atlas, 4.0 mm screws were inserted. According to the anatomy of the occipital condyle, vertebral artery filling experiments and CT testing, the results of the position of inserting screws were examined. Results Twenty fresh body heads met the criteria of CT examinations, and 40 complete occipital condyles were chosen. According to the position of inserting screws measured by CT, screws were successfully inserted in 36 of the 40 occipital condyles. Anatomy and postoperative CT scanning demonstrated that the hypoglossal canal was not damaged, and the screws did not pierce the inner or outer side wall of the occipital condyle. The vertebral artery was not damaged in all heads. However, 4 crews pierced the inner side wall of the occipital condyle. The horizontal distances between the position of inserting screws and the margin medialis of the occipital condyle were （7.6±0.9） mm （left） and （7.3±0.6） mm （right）, respectively, and there was no significant difference between them. The vertical distances between the position of inserting screws and the basis cran

关 键 词：枕骨 骨螺丝 解剖学 局部 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]