寰椎椎弓根置钉技术的断面解剖和重建CT参数研究  

Cross-sectional Anatomy and Reconstructed CT Parameters of Pedicle Screw Placement in Atlas

作　　者：王建华[1] 李哲[1] 付金利 裴铎 孙贺[1] 张义龙[1] WANG Jianhua;LI Zhe;FU Jinli(Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院脊柱外科,河北承德067000 [2]承德医学院生物医学工程系,河北承德067000

出　　处：《河北医学》2019年第10期1703-1706,共4页Hebei Medicine

基　　金：河北省承德市科技支撑计划项目,(编号:201606A049)

摘　　要：目的:通过重建CT测量以及断面解剖分析,探究寰椎的准确进钉位置,确定进钉的恒定参考系,并通过对所选参考系与钉道角度关系的测量确定进钉方向及角度,为寰椎椎弓根置钉技术的临床操作提供解剖学和重建CT的数据参考。方法:采用游标卡尺和量角器测量20例40侧寰椎标本,采用GELightSpeed64Pro螺旋CT操作软件(ADW4.2)测量20例40侧正常人的寰椎三维CT图片。结果:经重建CT、断面解剖测量显示:①寰椎椎动脉沟底部后弓最薄宽度(w)>其高度(H),高度H4.6±1.5mm,4.5±1.3mm;宽度w9.5±2.0mm,8.9±1.9mm。②寰椎后弓入钉点与后结节的横向距离S1:21.2±3.5mm;20.8±3.6mm。③寰椎钉道长度(AB):26.1±4.4mm;25.6±3.9mm。④寰椎背侧侧块下方内缘与外缘的间距S2:11.1±1.1mm;11.5±1.2mm。⑤钉道纵向角(Y):4.1度±0.7度,4.7度±0.9度,钉道横向角(X):10.9度±5.2度,10.2度±4.6度。⑥横突孔内侧壁至椎管外缘距离S3:8.0±1.4mm;7.8±1.5mm。两者的各个参数均无显著差异(P>0.05)。结论:标本解剖学测量和重建CT的测量结果具有一致性,以后弓上寰椎侧块下方内缘与外缘间距中点的投影距离椎动脉沟底部后弓最薄处的纵向距离2mm处作为寰椎椎弓根螺钉的入钉点;置钉纵向角取3度~5度,横向角取6度~16度;长度是21.7~30.5mm、直径3.5mm较为客观、安全、可靠,同时三维重建CT可以提供更加具体、个体化的置钉参考依据。Objective: To reconstruct the CT measurements and cross section anatomy,explore the atlas of the nail into the position accurately,to determine the nail into the constant reference frame,and based on the selected reference frame and into the nail Angle relationship of measurement to determine the direction and point of view,for the atlas pedicle nailing technology to provide the anatomical and clinical operation reconstruction CT data reference. Methods: 20 atlas specimens of 40 sides were measured with vernier calipers and protractors. The atlas three-dimensional CT images of 20 normal subjects were measured with GE Light Speed 64 Pro spiral CT operating software (ADW4.2). Results: The reconstructed CT and sectional anatomical measurements showed that: the thinnest width of the posterior arch at the base of the atlas vertebral artery sulcus (w)> its height (H),the height of the arch was H4.6±1.5mm),the height of the arch was 4.5±1.3mm,the width of the arch was 9.5±2.0mm,and the width was 8.9±1.9mm. The transverse distance between the screw entry point and the posterior tubercle of the posterior arch of the atlas is S1:21.2±3.5 mm and 20.8±3.6 mm. The length of atlas screw track (AB): 26.1±4.4 mm;25.6 ±3.9 mm. The distances between the inner and outer edges of the dorsal mass of the atlas are S2:11.1±1.1 mm and 11.5±1.2 mm. Longitudinal angle of nail track (Y): 4.1±0.7,4.7±0.9,transverse angle of nail track (X): 10.9±5.2,10.2±4.6. The distance from the medial wall of the transverse foramen to the outer edge of the spinal canal was S3:8.0+1.4 mm and 7.8±1.5 mm. There was no significant difference between the two parameters (P > 0.05). Conclusion: The results of anatomical measurement and reconstructed CT were consistent. The projection distance between the middle point of the distance between the inner edge and the outer edge of the lateral mass of the upper arch and the thinnest point of the posterior arch at the bottom of the vertebral artery sulcus was 2 mm. The longitudinal angle of the screw wa

关 键 词：寰椎 椎弓根 三维CT 解剖 

分 类 号：R687.3[医药卫生—骨科学]