后路经寰枕关节-枕骨髁-斜坡置钉技术的可行性和安全性研究  

Feasibility and safety of posterior atlantooccipital joint-occipital condyle-clivus screw fixation

作　　者：周树一 许楠健[1] 王扬[1] 施凯日 赵旭晨 华鹏程 马维虎[1] ZHOU Shuyi;XU Nanjian;WANG Yang;SHI Kairi;ZHAO Xuchen;HUA Pengcheng;MA Weihu(Ningbo No.6 Hospital,Ningbo 315040,Zhejiang,China;School of Medicine,Ningbo University,Ningbo 315211,Zhejiang,China)

机构地区：[1]宁波市第六医院,浙江宁波315040 [2]宁波大学医学院,浙江宁波315211

出　　处：《中医正骨》2022年第12期8-13,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(2020391275);宁波市科技计划项目(202003N4299);宁波市鄞州区农业与社会发展科技项目(2020AS0074)。

摘　　要：目的:探讨后路经寰枕关节-枕骨髁-斜坡置钉技术的可行性与安全性。方法:收集12具包含完整上颈椎骨性结构的新鲜冰冻尸体头颅标本,直视下将直径2.0mm的克氏针经寰枕关节-枕骨髁-斜坡植入标本后,拍摄X线片并测量克氏针钉道头倾角、内倾角;CT扫描标本,重点观察克氏针是否经过寰枕关节,是否在斜坡内,是否穿破寰椎内侧壁及枕骨髁内外侧壁,是否侵入舌下神经管、椎动脉孔、蝶窦;解剖标本,重点观察寰椎侧块、枕骨髁内外侧骨质有无破损,克氏针是否侵入舌下神经管、是否突破斜坡两侧及上部的骨质;拔出克氏针,用电子游标卡尺测量克氏针进入骨组织的部分即钉道长度。结果:12具标本的克氏针钉道内倾角20.29°±3.10°,钉道头倾角53.51°±4.61°,钉道长度(52.03±1.02)mm;左、右侧钉道内倾角、头倾角及长度比较,差异均无统计学意义[20.23°±3.35°,20.34°±2.98°,t=-0.523,P=0.611;53.45°±4.64°,53.57°±4.79°,t=-0.496,P=0.630;(51.93±1.15)mm,(52.12±0.92)mm,t=-1.161,P=0.270]。CT扫描结果显示,克氏针均经过寰枕关节且均在斜坡骨质内,均未穿破寰椎内侧壁及枕骨髁内外侧壁,均未侵入舌下神经管、椎动脉孔、蝶窦。标本解剖后观察结果显示,寰椎侧块、枕骨髁内外侧骨质均无破损,克氏针均未侵入舌下神经管、均未突破斜坡两侧及上部的骨质。结论:后路经寰枕关节-枕骨髁-斜坡置钉技术在解剖学和影像学上具有可行性和安全性,可作为后路枕颈融合术的补充。Objective:To investigate the feasibility and safety of posterior atlantooccipital joint-occipital condyle-clivus screw fixation.Methods:Twelve fresh frozen cadaveric skull specimens containing complete upper cervical spine were collected.Under direct vision, 2.0 mm diameter Kirschner wires were implanted into the specimens through the atlantooccipital joint-occipital condyle-clivus, followed by X-ray imaging and the measurement of head tilting and leaning angle of the Kirschner wire trajectory.CT scan was performed to observe whether Kirschner wires passed through the atlantooccipital joint, whether they were in the clivus, whether they broke the medial wall of the atlas and the lateral wall of the occipital condyle, and whether they invaded the hypoglossal canal, vertebral foramina, and sphenoid sinus.The specimens were dissected to primarily observe whether the lateral atlas and the medial and lateral bones of the occipital condyle were damaged, whether Kirschner wires invaded the hypoglossal canal, and whether Kirschner wires broke through the bones on both sides and upper part of the clivus.The Kirschner wires were withdrawn and an electronic caliper was employed to measure the distance of Kirschner wire trajectory in the bone tissues.Results:The leaning angle and head tilting angle of the Kirschner wire trajectory of the 12 specimens were 20.29°±3.10° and 53.51°±4.61°,and the distance of trajectory was(52.03±1.02)mm.There was no significant difference in the leaning angle and head tilting angle, as well as distance of left and right trajectories(20.23°±3.35° vs 20.34°±2.98°,t=-0.523,P=0.611;53.45°±4.64° vs 53.57°±4.79°,t=-0.496,P=0.630;51.93±1.15 vs 52.12±0.92 mm, t=-1.161,P=0.270).As revealed by CT scan, all Kirschner wires passed through the atlantooccipital joint and were in the clivus, without penetrating the medial wall of the atlas and the lateral wall of the occipital condyle, and without invading the hypoglossal canal, vertebral foramina, and sphenoid sinus.The anatomical results

关 键 词：脊柱融合术 寰枕关节 枕骨 解剖学 影像学检查 可行性研究 安全性研究 

分 类 号：R687.3[医药卫生—骨科学]