后路经寰枕关节-斜坡螺钉枕颈固定技术的可行性研究  

Anatomic study of posterior atlanto-occipital-clivus screw technique

作　　者：李豪杰 施凯日 马维虎[2] 蒋伟宇[2] 胡旭栋[2] 王扬[2] 徐顶立 周树一 彭宇杰 阮超越 许楠健[2] Li Haojie;Shi Kairi;Ma Weihu;Jiang Weiyu;Hu Xudong;Wang Yang;Xu Dingli;Zhou Shuyi;Peng Yujie;Ruan Chaoyue;Xv Nanjian(Graduate School,Medical College of Ningbo University,Ningbo 315211,China;Departmentof Spinal Surgery,Ningbo 315040,China)

机构地区：[1]宁波大学医学院研究生院,315211 [2]宁波市第六医院脊柱外科,315040

出　　处：《中华骨科杂志》2021年第3期165-175,共11页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81572217);浙江省自然科学基金(LY19H060002,LY18H060007);浙江省医药卫生科技项目(2020391275);宁波市科技局自然科学基金(202003N4299)。

摘　　要：目的探讨经寰枕关节-斜坡螺钉行后路枕颈固定的解剖学可行性。方法回顾性分析2017年2月至2019年11月60例来院就诊并行枕颈区CT检查的成人CT影像资料,排除枕颈区域感染、损伤、肿瘤和畸形。利用CT扫描的Dicom数据在Mimics软件中进行解剖学参数测量,测量参数包括斜坡前缘、中部的高度和宽度,斜坡前方软组织最薄处厚度,枕骨髁关节面前后径、横径及内倾角,舌下神经管最低点至枕骨髁关节面垂直距离,上关节面前后径和横径,侧块高度,寰椎下关节突高度和宽度;再行三维数字化建模并模拟置入直径为3.5 mm的螺钉,在3-Matic软件中测量置钉参数,包括螺钉内倾角、头倾角及长度。取8具尸体标本,后方暴露颅颈交界区,按上述置钉参数将直径为3.5 mm的钛合金螺钉自寰椎下关节突与后弓移行处置入,经寰枕关节至斜坡;然后用摆锯沿钉道剖开,观察螺钉的钉道轨迹,验证置钉的安全性和有效性。结果男性斜坡前缘高度和宽度分别为(16.8±2.5)mm和(20.1±3.1)mm;斜坡中部分别为(9.7±2.3)mm和(22.4±3.7)mm。斜坡前方软组织最薄处厚度为(5.8±1.48)mm。枕骨髁前后径为(19.1±1.9)mm,横径(12.6±2.0)mm,内倾角为33.7°±4.5°。舌下神经管最低点至枕骨髁关节面垂直距离为(9.6±1.1)mm。寰椎侧块高度为(12.9±2.4)mm。上关节面前后径为(21.7±1.9)mm,横径为(11.7±1.4)mm。寰椎下关节突宽度为(14.9±1.4)mm,高度为(5.7±0.85)mm。螺钉进钉点至侧块移行中点所在垂线的距离为(2.5±0.6)mm,至中点所在水平线的距离为(2.3±0.7)mm;内倾角为18.4°±1.6°,调整范围为15.0°±2.8°;头倾角为55.6°±3.1°,调整范围为10.4°±2.4°;钉道长度为(53.0±2.8)mm。女性的解剖学参数较男性略小,差异有统计学意义,左右侧参数比较差异无统计学意义。8具标本的经寰枕关节-斜坡螺钉均能安全、有效置入。结论经寰枕关节-斜坡螺钉可在不损伤神经、血管Objective To investigate the anatomical safety and feasibility ofposterior occipitocervical fixation with atlan-tooccipital-clivus screw.Methods Data of 60 patients who treated in the spinal department of our hospital with upper cervical computed tomographic scans from February 2017 to November 2019 were retrospectively collected.Occipitocervical infection,injury,tumor and deformity were excluded.The Mimics software was used to reconstruct the occiput,atlas and measure the anatomical parameters,including the height and width of the anterior edge of the clivus,the height and width of the middle part of the clivus,the thinnest distance of the soft tissue in front of the clivus,the anteroposterior diameter,transverse diameter,the angle of inside tilting in coronary plane of the occipital condyle,the distance from the hypoglossal canal to the atlantooccipital articular surface,the anteroposterior diameter and transverse diameter of the superior joint of atlas,the height of the lateral mass,and the height and transverse diameter of the inferior articular process of the superior atlas joint.The three-dimensional digital modeling was performed and the screw diameter of 3.5mm was simulated.3-Matic software were used to measure the screw placement parameters,including the inside tilting angle in coronary plane of screw,and the angle of upper tilting in sagittal plane and length of screw.The atlanto-occipital junction was exposed at the rear of 8 cadavers.According to the above parameters,the titanium alloy screws with a diameter of 3.5 mm were transferred from the inferior articular process and posterior arch of the atlas to the clivus through the atlantooccipital.Finally,the screw path was cut along the nail path with a pendulum saw,and the track of the screw was observed to confirm the safety and effectiveness of the screw.Results The leading edge height and width of male clivus was 16.8±2.5 mm and 20.1±3.1 mm.The middle part of the clivus was 9.7±2.3 mm and 22.4±3.7 mm.The thinnest soft tissue in front of the clivu

关 键 词：寰枕关节 颅窝 后 螺钉 

分 类 号：R687.3[医药卫生—骨科学]