颈椎弓根螺钉内固定的解剖学研究  

Anatomical study of pedicle screw fixation for the cervical spine

作　　者：闫德强[1] 谢志军[1] 于有德 李炳辉[1] 常西海[1] 孙立民[1] 张汉瑜 范志强 

机构地区：[1]山东省淄博市临淄区人民医院骨科,255400 [2]山东省淄博卫生学校解剖教研室

出　　处：《中华骨科杂志》2002年第11期657-661,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈椎弓根螺钉内固定的定位定向方法.方法设计椎体平面固定架,用游标卡尺、角度计和标本涂钡X线片对40具成人颈椎干燥标本进行解剖学观测.内容包括:椎弓根高度、宽度、轴线长度、轴线角度,上下关节突间侧凹的深度及存在率,椎弓根上下切迹、关节面、椎弓后上缘与椎体上平面的垂直高度及关节突后平面角度.结果C2～C7上下关节突间侧凹的存在率为100%.颈椎弓根完全可以接受直径3.5 mm、长28 mm的螺钉内固定;椎弓根在椎体平面上的外展角C1为20°,C2上为25°、下为44°,C3～C5为45°～47°,C6、C7为40°.除寰枢椎外,颈椎弓根后结构、关节突间侧凹对应椎弓根轴线.椎弓根的指向与关节突后平面角度密切相关:椎弓后上缘高度线、关节突后平面和椎体上平面三者之间形成前后两个180°互补角,前角大于90°时椎弓根指向前下方,小于90°时指向上终板.关节突后平面的平均角度C3为-2.30°+1.82°,C4为2.32°+1.98°,C5为2.42°±1.87°,C6为2.36°±1.56°,C7为15.22°+2.68°.进钉点在C1为后弓缘与上关节突后突尖中垂线的交点,C2为上椎弓根外缘矢状线与下关节突上缘水平线交点,C3～C7为垂直于关节突后平面的椎弓后上缘水平线与关节突间侧凹外缘的矢状线交点.结论关节突间侧凹、侧块后平面及椎弓后上缘,三者具有直角定位定向的解剖学特征,标志显著,术中无须过多显露,容易寻找,定位准确,可为临床提供一种既经椎弓根又与终板平行的定位定向方法.Objective To develop an anatomically based method of accurate pedicle screw insertion for cervical spine fixation. Methods Forty adult cervical spine were mounted onto a specially designed jig. Parameters including height, width, length, and axis angulation of pedicles,depth of lateral fovea, height of superior posterior border of arcus vertebrae and angles of posterior articular prominance as well were mea sured with vernier calibre or goniometer either directly or radiographically. Results Lateral fovea did exist in all C2-C7 vertebrea. The pedicles of the cervical spine were wide and long enough to accept 28 mm long 3.5 mm screws. The abduction angle of the screw was 20° at the C1 level, 25° superiorly and 44° inferiorly at the C2 level, 45° to 47° from level C3 to C5, and 40° from level C6 to C7. The angle of posterior plane of articular mass was minus 2.30° at C3,it was 2.32° to 2.42° from level C4 to C6, and it was 15.22° at C7. The stability of cervical spine fixation and neurological improvement were satisfactory. Conclusion Transpedic ular screw fixation for the cervical spine is practicable. Anatomical symbol of the superior posterior border of the arcus vertebrae and the posterior plane of articular mass and the lateral fovea is easy to be exposed and identified in the operation. Transpedicular screw can be precisely inserted easily and safely for the cervical spine fixation with limited exposure and without using fluoroscopic guidance.

关 键 词：颈椎弓根螺钉 内固定 解剖学 研究 

分 类 号：R68[医药卫生—骨科学]