儿童寰椎椎弓根螺钉最佳进钉点及进钉方法  

Guidelines for selection of entry point and Angle of atlas pedicle screw for children

作　　者：丁延 宋瑞鹏[1] 蔡一鸣[1] 范道洋 薛登 肖阳[1] 孙俊辉 王卫东[1] Ding Yan;Song Ruipeng;Cai Yiming;Fan Daoyang;Xue Deng;Xiao Yang;Sun Junhui;Wang Weidong(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院骨科,450000

出　　处：《中华实验外科杂志》2020年第11期2114-2116,共3页Chinese Journal of Experimental Surgery

基　　金：河南省高等学校重点科研项目(20A320069);百千万创新驱动助理工程项目。

摘　　要：目的探讨儿童寰椎椎弓根螺钉理想进钉点及进钉角度。方法选取在2017年1月至2020年6月于郑州大学第一附属医院接受颈椎64层CT扫描的2~6岁儿童,从中筛选出153例符合标准的儿童,每个年龄段中23~45例,平均30例,将符合要求的儿童按性别分为两组,男100例,女53例。测量双侧寰椎椎弓根螺钉在不同内倾角度时可利用间隙宽度。以及在可利用间隙宽度用达到最宽时的椎弓根螺钉钉道长度、进钉点到侧块与后弓内缘交点的水平距离,以及内倾角度。通过Sudentt检验分析性别差异是否存在统计学意义。结果当钉道内倾角度与前后弓交点所在直线平行时,螺钉可利用间隙宽度最大(8.02±1.06)mm。钉道与侧块和前后弓内缘交点的连线平行时,钉道长度为(24.75±3.34)mm,进钉点距侧块与后弓内缘交点水平距离为(5.70±1.10)mm,最佳内倾角角度为(20.93±3.07)°。不同性别,患儿椎弓根螺钉钉道长度(P>0.05),进钉点至侧块与后弓内缘交点水平距离(P>0.05),进钉最佳内倾角度(P>0.05)差异均无统计学意义。结论6岁以下儿童寰椎椎弓根螺钉时,选择距侧块与后弓内缘交点水平距离为(5.70±1.10)mm做垂线与后弓水平中线交点为进钉点是安全可行的,钉道内倾角度选为钉道与前后弓交点所在直线平行(20.93±3.07)°时为进行儿童寰椎椎弓根螺钉固定的最佳内倾角度。Objective Study the ideal entry point and angle of children atlas pedicle screw.Methods Select children aged 2-6 years who underwent 64-slice CT scan of cervical spine at the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2020.A total of 153 children meet the standard,23-45 in each age group,an average of 30,children who meet the requirements are divided into two groups according to gender,male(n=100),female n=53.The clearance width of atlas pedicle screw on both sides was measured at different inclination angles.The length of the pedicle screw path,the horizontal distance from the entry point to the intersection of the lateral mass and the inner edge of the posterior arch,and the Angle of inclination were measured when the clearance width was used to the maximum.Student T test was used to analyze whether the gender difference was statistically significant.Results When the Angle of the screw path is parallel to the straight line where the bow intersects the front and rear,the clearance width of the screw can be maximum(8.02±1.06)mm.The length of the nail path is(24.75±3.34)mm when the path is parallel with the connecting line between the side block and the intersection point of the front and rear arches.The distance between the entry point and the intersection point of the side block and the inner edge of the rear arch was(5.70±1.10)mm,and the optimal Angle of inclination was(20.93±3.07)°.There is no statistical difference in the measurement of atlas parameters of children of different genders(P>0.05).Conclusion Atlas pedicle screw in children under 6 years of age.It is safe and feasible to select the point(5.70±1.10)mm outwards from the intersection point of the lateral block and the inner edge of the posterior arch as the vertical line,and the point of intersection with the horizontal midline of the posterior arch as the entry point.When the Angle of the entry passage was parallel to the straight line of the intersection point of the anterior and posterior arches(20.93±3.07)�

关 键 词：寰枢椎 寰椎椎弓根 颈椎重建术 儿童 计算机断层扫描 儿科 椎弓根螺钉 体层摄影术 上颈椎病 

分 类 号：R726.8[医药卫生—儿科]