TARP-Ⅲ手术枢椎螺钉置钉参数CT测量及与解剖测量的对比研究  

A comparative study of C2 screw placement parameters between CT-based and anatomical measurements during TARP-Ⅲ procedure

作　　者：李学仕[1] 吴增晖[2] 夏虹[2] 马向阳[2] 艾福志[2] 王建华[2] 麦小红[2] 尹庆水[2] 

机构地区：[1]南方医科大学,广州510515 [2]广州军区广州总医院骨科医院,510010

出　　处：《中国骨科临床与基础研究杂志》2015年第2期95-103,共9页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省产学研重点项目(2012B091000161)

摘　　要：目的比较Ⅲ代经口寰枢椎复位钢板(TARP-Ⅲ)手术中C2经口前路关节突螺钉(C2TOAMS)/C2经口前路经椎弓根螺钉(C2TOTPS)CT置钉参数与解剖测量数据之间的差异,分析实际置钉过程中存在的问题。方法收集广州军区广州总医院骨科医院2008年3月至2012年8月行TARP-Ⅲ手术的75例成年患者的术后薄层CT数据,获得C2TOAMS/C2TOTPS临床实际置钉参数。由2位测量者分别在不同平面上进行测量,计算观察者内和观察者间组内相关系数(ICC);并将上述参数与前期解剖学测量结果进行对比,同时比较左右两侧测量结果的差异。结果临床实际置入的C2TOAMS/C2TOTPS进钉点距枢椎侧块关节面的平均距离(双侧)为4.6 mm,左右两侧进钉点距正中矢状面的平均距离分别为7.6 mm和9.3 mm,左右两侧实际骨性钉道平均长度分别为16.3 mm和17.3 mm;左右两侧平均进钉外展角分别为16.9°和15.8°,平均进钉下倾角分别为—1.2°和0.2°。CT测量可靠性评价:观察者内ICC为0.94、0.95,观察者间ICC为0.94。结论 C2TOAMS/C2TOTPS实际进钉点和进钉方向变异较大,下倾角不够,个性化术前计划和术中X线引导并不能满足C2TOAMS/C2TOTPS精确置钉的需要,应辅以其他引导方式,以进一步提高经口枢椎螺钉置钉的准确度和安全性。Objective To compare the differences between CT-based parameters of C2 transoral articular mass screw (C2TOAMS)/C2 transoral transpedicular screw (C2TOTPS) placement and their anatomical measurement data during transoral atlantoaxial reduction plate (TARP)-Ⅲ procedure, and to analyze the existing problems in the process of actual screws placement. Methods Postoperative CT thin-slice data from 75 adult patients underwent TARP-Ⅲ procedure from March 2008 to August 2012 in Guangzhou General Hospital of Guangzhou Military Command were collected, and then parameters of the clinically placing C2TOAMS/C2TOTPS were measured by 2 observers from different planes. The intraclass correlation coefficient (ICC) was calculated to access the intra-observer reliability and the inter-observer repeatability of the measurement results, and the differences between these clinical parameters and the previous measured anatomical parameters were compared, simultaneously, the variance between two sides was also analyzed. Results The mean distance between the screw entry point of C2TOAMS/C2TOTPS and the lateral articular surface of C2 was 4.6 mm on both sides. The average distance from the screw entry point on the left and the right side to the mid-sagittal plane was 7.6 mm and 9.3 mm respectively, and the average length of intraosseous screw trajectory was 16.3 mm on the left, and 17.3 mm on the right. The mean transverse angle was 16.9° on the left side and 15.8° on the right side, and the average declination angles were-1.2° on the left side and 0.2° on the right side respectively. Reliability test of CT image measurement showed that intra-observer ICC was 0.94, 0.95, and inter-observer ICC was 0.94. Conclusions During TARP-Ⅲ procedure, entry point locations and angles of C2TOAMS/C2TOTPS are highly variable with insufficient declination angles. As a result, individualized preoperative planning and intraoperative X-ray guiding are not necessary for accurate screw placement. Other guidance methods should be accompanied so as to

关 键 词：寰枢关节 枢椎 关节不稳定性 经口手术 骨板 骨螺丝 CT测量 解剖学测量 

分 类 号：R687.3[医药卫生—骨科学]