应用枢椎关节面下螺钉固定治疗椎动脉变异的疗效评估  

Clinical application of atlantoaxial subarticular screw fixation for vertebral artery variation

作　　者：程晓非 杨二柱 田海军[1] 孙晓江[1] 赵长清[1] 赵杰[1] Cheng Xiaofei;Yang Erzhu;Tian Haijun;Sun Xiaojiang;Zhao Changqing;Zhao Jie(Shanghai Key Laboratory of Orthopaedic Implants,Department of Orthopaedic Surgery,Shanghai Ninth People's Hospital,Shanghai JiaoTong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海市骨科内植物重点实验室,200011

出　　处：《骨科临床与研究杂志》2022年第5期262-266,共5页Journal Of Clinical Orthopedics And Research

基　　金：国家自然科学基金(82130073,81871790,81972136)。

摘　　要：目的 评估采用寰枢椎关节面下螺钉固定治疗椎动脉变异的可行性和有效性。方法 2013年1月至2021年1月上海交通大学医学院附属第九人民医院骨科采取枢椎关节面下螺钉行寰枢椎后路固定的椎动脉变异患者17例。术前通过CT二维重建在冠矢轴三个平面上确定螺钉轨迹,测量最狭窄处的直径。随后根据轨迹确定螺钉进针点。在矢状位测量螺钉轨迹长度和头倾角度。在轴位测量内倾角度,同时测量峡部长度作为峡部螺钉轨迹的长度。结果 关节面下螺钉轨迹处的最小直径为(5.5±0.9)mm,显著高于椎弓根最小直径(P<0.05)。进针点距离寰枢椎关节面的距离为(2.7±0.4)mm。距离椎管内壁距离为(3.4±0.3)mm。螺钉轨迹头倾角度为(7.4±2.5)°,内倾角度为(12.2±2.1)°。关节面下螺钉轨迹长度为(20.4±2.4)mm,峡部螺钉轨迹长度为(16.9±2.6)mm,两者间差异有统计学意义(P<0.05)。结论 当进行寰枢椎固定时,对于因椎动脉变异导致枢椎椎弓根狭窄而不适合接受椎弓根螺钉固定的患者。枢椎关节面下螺钉可作为替代方案。术前CT重建测量有助于安全有效地植入螺钉。Objective To evaluate the feasibility and efficacy of atlantoaxial subarticular screw fixation for vertebral artery variation. Methods From January 2013 to January 2021, clinical data were obtained from 17 patients receiving atlantoaxial fixation using atlantoaxial subarticular screws in Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital. Two-dimensional CT reconstruction was used to determine screw trajectory. The diameter of the narrowest place, the distance of entry point to atlantoaxial articular surface and spinal canal, the path length and angle of the screw trajectory and the length of the isthmus interarticularis were measured. Results The diameter of the subarticular trajectory was(5.5±0.9)mm, which was significantly higher than the diameter of the pedicles(P<0.05). The distance of entry point to atlantoaxial articular surface and spinal canal was(2.7±0.4)mm and(3.4±0.3)mm, respectively. The insertion angle of screw was(7.4±2.5)° cephalad to the axial plane and(12.2±2.1)° medial to the sagittal plane. The length of the screw trajectory and the isthmus was(20.4±2.4)mm and(16.9±2.6)mm, respectively, with a significant difference between them(P<0.05). Conclusion Atlantoaxial subarticular screw could be utilized as an alternative when pedicle screw is not suitable for axial fixation due to vertebral artery variation and narrowing of the pedicles. Preoperative CT reconstruction measurements are necessary for safe and effective screw insertion.

关 键 词：枢椎 椎动脉 螺钉 

分 类 号：R687.3[医药卫生—骨科学]