颈椎单开门微型钢板固定在颈椎侧块置钉方法改进的解剖研究  

An anatomical study of the improved screw placement in the mini-plate fixation of lateral mass for cervical open-door laminoplasty operation

作　　者：吴洁石 薛骏 袁凤来 赵鹏 赵全明 徐瑞生 Wu Jieshi;Xue Jun;Yuan Fenglai;Zhao Peng;Zhao Quanming;Xu Ruisheng(Department of Orthopedics,Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Anatomy,Medical College of Jiangnan University,Jiangsu 214122,China)

机构地区：[1]江南大学附属医院骨科,江苏无锡214122 [2]江南大学医学院解剖学教研室,江苏无锡214122

出　　处：《中国临床解剖学杂志》2021年第5期503-506,共4页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金面上项目(81770876);无锡市“太湖人才计划”医疗卫生高端人才科研项目(2020-50)。

摘　　要：目的为颈椎单开门手术中微型钢板侧块固定螺钉更为安全的钉道和置钉方向提供解剖学基础。方法选取50套C3~7椎骨标本,确定微型钢板固定侧块时上、下两枚螺钉在颈椎侧块上的进钉点A和B,测量垂直颈椎侧块表面进钉的钉道长度A1和B1,以及头倾15°进钉的钉道长度A2和B2。结果A1的平均值C3(9.4±1.2)mm、C4(11.7±2.8)mm、C5(12.9±2.5)mm、C6(12.0±2.3)mm、C7(10.4±1.8)mm;A2的平均值C3(11.9±1.6)mm、C4(15.3±1.7)mm、C5(15.7±1.7)mm、C6(14.2±1.3)mm、C7(13.5±1.0)mm均大于11 mm;B1的平均值C3(4.7±0.6)mm、C4(5.0±1.1)mm、C5(5.8±0.9)mm、C6(5.5±0.6)mm、C7(5.3±0.4)mm,钉道长度<5 mm的占比分别为57%、46%、28%、27%和35%。B2的平均值C3(6.8±0.8)mm、C4(7.0±2.1)mm、C5(7.8±1.4)mm、C6(8.5±0.8)mm、C7(7.6±0.6)mm均大于5 mm。结论微型钢板颈椎侧块固定时,为避免螺钉尖端穿出颈椎侧块前方,宜按头倾15°建立钉道,头端一枚可选择长度9 mm的螺钉、尾端一枚宜选择长度5 mm的螺钉,头倾15°建立钉道可以增加钉道的长度并避免螺钉尖端突破侧块前方而破坏小关节的关节面。Objective To provide the anatomical basis for a safer screw direction and screw path for cervical microplate side mass fixation screws in cervical open-door laminoplasty operation. Methods The points of A and B on the surface of lateral mass for setting cephalic and caudal screws to fix the plate were determined in 50 specimens of C3~C7 vertebra, the length of vertical screw path A1 and B1 and head tilt of 15°A2 and B2 were measured. Results The mean value of A1 length in cervical vertebra was C3(9.4 ± 1.2)mm, C4(11.7±2.8) mm, C5(12.9±2.5) mm, C6(12.0±2.3) mm, C7(10.4±1.8) mm. The mean value of A2 length was C3(11.9±1.6) mm, C4(15.3±1.7) mm, C5(15.7±1.7) mm, C6(14.2±1.3) mm and C7(13.5±1.0) mm, which were all greater than 11 mm. The mean value of B1 length was C3(4.7±0.6) mm, C4(5.0±1.1) mm, C5(5.8±0.9) mm, C6(5.5±0.6) mm, and C7(5.3±0.4) mm. The percentage of B1 length less than 5 mm in the C3, C4, C5,C6 and C7 vertebrae was 57%, 46%, 28%, 27% and 35%, respectively. The average length of B2 nail track in all cervical vertebrae specimens C3 was(6.8±0.8) mm, C4(7.0±2.1) mm, C5(7.8±1.4) mm, C6(8.5±0.8) mm,and C7(7.6±0.6) mm, which was greater than 5 mm. Conclusions When the cervical mini-plate is fixed to the lateral mass of cervical spine, in order to avoid screw’s over length, it is necessary to set the screw path at the head tilt of 15°. The length of the cephalic screw can be 9 mm, and the caudal one should be 5 mm, which can efficiently avoid screw protruding out facet and hurting the articular cartilage of the cervical spine small joint.

关 键 词：颈椎病 颈椎 椎管扩大术 脊髓减压术 骨钉 颈痛 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]