寰枕融合患者枢椎椎弓根形态及对手术治疗的影响  

MORPHOLOGY OF AXIS PEDICLE AND ITS IMPACT ON SURGICAL TREATMENT IN PATIENTS WITH ATLANTO-OCCIPITAL FUSION

作　　者：郭胜利 程岗 张剑宁 乔广宇 GUO Shengli;CHENG Gang;ZHANG Jianning;QIAO Guangyu(Department of Neurosurgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China)

机构地区：[1]中国人民解放军总医院第六医学中心神经外科,北京100048 [2]中国人民解放军总医院第一医学中心神经外科,北京100048

出　　处：《精准医学杂志》2020年第3期189-191,196,共4页Journal of Precision Medicine

基　　金：装备军内科研计划项目(LB2019A010010)。

摘　　要：目的探讨寰枕融合患者枢椎椎弓根形态及其对手术治疗的影响。方法以2018年5月—2019年3月我院收治的寰枕融合患者49例作为病例组,无颅颈交界区疾病的患者30例作为对照组,所有患者均行颅颈交界区薄层CT扫描三维重建,采用Mimics软件测量患者枢椎椎弓根宽度、高度及内倾角和上倾角。病例组患者采用后路寰枢椎钉棒复位内固定手术进行治疗。结果病例组枢椎椎弓根高度为(4.62±1.39)mm,宽度为(4.13±1.45)mm,对照组枢椎椎弓根高度为(5.54±1.83)mm,宽度为(4.88±1.22)mm,两组比较差异具有显著的统计学意义(t=3.33、3.59,P<0.05)。对于枢椎椎弓根发育狭小,无法植入枢椎椎弓根螺钉的患者,11例植入颈2下关节突螺钉治疗,3例植入颈3下关节突治疗,6例植入颈3椎弓根螺钉治疗。结论寰枕融合患者枢椎椎弓根较正常狭小,植入螺钉难度更大,无法安全植钉时应采用备选方案进行治疗。Objective To investigate the morphology of axis pedicle and its impact on surgical treatment in patients with atlanto-occipital fusion.Methods A total of 49 patients with atlanto-occipital fusion who were admitted to our hospital from May 2018 to March 2019 were enrolled as case group,and 30 patients without disease in the craniocervical junction were enrolled as control group.All patients underwent 3D reconstruction of thin-slice CT scan of the craniocervical junction,and Mimics software was used to measure the width,height,internal angle,and upward angle of the axis pedicle.The patients in the case group were treated with atlantoaxial pedicle screw-rod reduction and internal fixation via the posterior approach.Results There were significant differences between the case group and the control group in height of the axis pedicle((4.62±1.39)mm vs(5.54±1.83)mm,t=3.33,P<0.05)and width of the axis pedicle((4.13±1.45)mm vs(4.88±1.22)mm,t=3.59,P<0.05).For the patients with narrow axis pedicle who were not able to undergo implantation of the C2 pedicle screw,11 were treated with the C2 inferior articular process screw,3 were treated with the C3 inferior articular process screw,and 6 were treated with the C3 pedicle screw.Conclusion Patients with atlanto-occipital fusion have a narrower axis pedicle than normal and it is more difficult to implant a pe-dicle screw,so an alternative treatment regimen should be adopted when the axis pedicle screw cannot be implanted safely.

关 键 词：寰枕融合 枢椎椎弓根 解剖学 局部 椎弓根钉 假体植入 MIMICS软件 

分 类 号：R622[医药卫生—整形外科] R323.41[医药卫生—外科学]