前路经寰枢关节解剖锁定钛板螺钉内固定系统的可行性及安全性研究  

Feasibility and safety of internal fixation with anterior atlantoaxial transarticular anatomic locking titanium plate and screws

作　　者：罗青林[1] 蔡贤华[1] 黄卫兵[1] 冯立文[1] 孙长笈[1] 

机构地区：[1]广州军区武汉总医院骨科,430070

出　　处：《中华创伤骨科杂志》2013年第12期1054-1058,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：目的探讨自行研制的前路经寰枢关节解剖锁定钛板螺钉内固定系统行寰枢椎固定的可行性及安全性。方法对30具福尔马林浸泡的正常国人枕颈部标本行寰枢椎CT三维重建，测量与前路经寰枢关节解剖锁定钛板螺钉内固定系统相关的解剖参数，以测得的参数为依据，在测量标本上建立本内固定系统的手术模型，行CT三维重建检查内固定位置，测量螺钉钉道参数。结果经寰枢关节螺钉冠状面上外偏角参考范围为14°～32°，理想外偏角为23．05°±1．90°，实际外偏角为23．22°±1．71°，矢状面上后倾角参考范围为14°～42°，理想后倾角为27．89°±2．67°，实际后倾角为27．96°±3．05°，钉道长度参考范围为19—33mm，理想钉道长度为（27．49±1．23）mm，实际钉道长度为（27．50±1．55）mm，理想钉道参数与实际钉道参数差异均无统计学意义（P〉0．05）；枢椎体固定螺钉水平面上内偏角参考范围为0～15°，矢状面上上倾角参考范围为0～50°，钉道长度参考范围为15～21mm。模拟行内固定术后影像学检查示钛板与枢椎表面匹配，所有螺钉钉道角度及长度均在术前参考范围内，无穿出骨质者。结论国人采用前路经寰枢关节解剖锁定钛板螺钉内固定系统行寰枢椎固定在解剖上是安全、可行的。Objective To investigate the feasibility and safety of internal fixation with anterior atlantoaxial transartieular anatomic locking titanium plate and screws. Methods Three-dimensional reconstruction was performed based on CT scans of 30 specimens of eraniovertebral junction, soaked in formalin, from normal Chinese adult cadavers. Anatomic parameters were measured pertinent to internal fixation with anterior atlantoaxial transarticular anatomic locking titanium plate and screws. The surgical models of the fixation system were created on the specimens according to the parameters measured. Then the positions of internal fixation system and screw trajectory parameters were measured after postoperative three-dimensional CT reconstruction. Results The lateral angulation of the atlantoaxial transartieular screw trajectory to the coronal plane ranged from 14° to 32° while the ideal angle was 23.05° -＋ 1.90° and the actual angle 23.22°± 1.71°; the posterior angulation to the sagittal plane ranged from 14° to 42° while the ideal angle was 27.89° ± 2.67° and the actual angle 27.96° ± 3.05°; the length of screw trajectory ranged from 19 mm to 33 mm while the ideal length was 27.49 ± 1.23 mm and the actual length 27.50 ± 1.55 mm. There was no significant difference between the ideal and the actual screw trajectory parameters （ P 〉 0. 05）. The inner angulation of the atlantoaxial screw trajectory to the horizontal plane ranged from 0 to 15°, the upper angulation to the sagittal plane ranged from 0 to 50°, and the screw trajectory length ranged from 15 mm to 21 mm. The postoperative radiographs showed the titanium plate and the atlantoaxial surface matched well, and the angles and lengths of all the screw trajectories were within the preoperative reference range, with no screw protruding the bone. Conclusion The internal fixation system with anterior atlantoaxial transarticular anatomic locking titanium plate and screws is anatomically safe and feasible for Chinese patients.

关 键 词：寰椎 枢椎 解剖学 不稳 前路 

分 类 号：R687.3[医药卫生—骨科学]