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寰椎前路侧块螺钉理想进钉点和进钉角度的定量解剖学研究

Ideal screw entry point and optimal trajectory for anterior C1 lateral mass screw: an anatomical study

摘要:

目的 探讨寰椎前路侧块螺钉的理想进钉点和进钉角度,为寰椎前路侧块螺钉的置钉技术提供解剖学依据.方法 征集健康成年人56名,其中女性28名、男性28名,平均年龄36.5岁(18 ~55岁),进行颈椎CT平扫.通过Mimics软件对志愿者的颈椎CT数据进行三维重建,然后依次分别测量寰椎侧块前部内侧(H1)、中间(H3)和外侧(H5)有效高度;寰椎侧块后部内侧(H2)、中间(H4)和外侧(H6)有效高度;通过比较在寰椎前路侧块螺钉外倾角从0°到30°以间隔5°增加过程中寰椎侧块的安全宽度,来找到理想外倾角度;通过测量寰椎前路侧块螺钉在矢状面上的进钉角度范围,来找到理想的矢状面进钉角度.结果 测得寰椎侧块前部内侧(H1)、中间(H3)和外侧(H5)有效高度平均分别为6.67 mm、12.09 mm和17.51 mm;寰椎侧块后部内侧(H2)、中间(H4)和外侧(H6)有效高度平均分别为8.17 mm、13.20 mm和18.22 mm;0°~30°的外倾角以间隔5°逐渐增大过程中的寰椎侧块安全宽度平均分别为4.73 mm、5.36 mm、5.90 mm、6.33 mm、6.44 mm、5.70 mm、4.38 mm,外倾角为δ时,寰椎侧块安全宽度平均为6.95 mm;寰椎前路侧块螺钉理想进钉点距离寰椎前结节与正中矢状面的交点距离为12.80 mm,与寰椎下关节面前缘的距离为6.87 mm.寰椎前路侧块螺钉在矢状面上的安全进钉角度范围为24.22°(-17.74°~6.48°).结论 寰椎前路侧块螺钉在横断面理想进钉角度平均为外倾21.14°,理想进钉点为寰椎前结节中点旁开12.80 mm,与下关节面前缘以上6.87 mm的交点;矢状面理想进钉角度为平均下倾5.63°;理论上寰椎前路侧块螺钉钉点和进钉角度的合理选择可以降低损伤脊髓、椎动脉和颈内动脉的风险,术前对患者行仔细的解剖学研究有助于降低手术风险.

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abstracts:

Objective To explore the ideal screw entry point and optimal trajectory for anterior C1 lateral mass screw internal fixation,and provide an anatomical basis for the technique of anterior C1 lateral mass screw placement.Methods A radiographic analysis of the anatomy of the C1 lateral mass using Computed tomography,CT scan was performed in cervical spine of 56 healthy Chinese adults (28 males,28 females; mean age,36.5 years; age range,18-55 years),by using the Mimics software to reconstruct the 3-D morphology of C1 lateral mass and measuring the inside,middle and outside effective height of the C1 lateral mass in front and back.Measuring the C1 lateral mass safe width with different extraversion angles range from 0° to 30° with a uniform interval of 5°,to find out the ideal extraversion angle.Measuring the range of sagittal angle,to find out the ideal sagittal angle.Results The inside (H1),middle (H3) and outside(H5) effective height of the C1 lateral mass in front is 6.67 mm,12.09 mm,and 17.51 mm,the inside(H2),middle(H4) and outside(H6) effective height of the C1 lateral mass in back is 8.17 mm,13.20 mm,and 18.22 mm.When the extraversion angle choose 0°,5°,10°,15°,20°,25°,30°,and δ,the relative results of safe width (SW) of lateral mass were 4.73 mm,5.36 mm,5.90 mm,6.33 mm,6.44 mm,5.70 mm,4.38 mm,6.95 mm averagely.The mean distance along the atlas anterior surface between the anterior tubercle and the screw entry point was 12.80 mm,the mean distance from the inferior border of the lateral mass to the screw entry point was 6.87 mm.The range of sagittal angle is 24.22° (-17.74° ~6.48°).Conclusions The ideal extraversion angle was 21.14°.The mean distance along the atlas anterior surface between the anterior tubercle and the screw entry point was 12.80 mm.The mean distance from the inferior border of the lateral mass to the screw entry point was 6.87 mm.The ideal sagittal angle is-5.63°.These measurements may facilitate anterior C1 lateral mass screw fixation decreasing the risk of injury to the spinal cord,vertebral artery,and internal carotid artery theoretically.Delineating the individual anatomy in each case with CT scan before surgery is recommended.

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作者: 胡勇 [1] 董伟鑫 [1] 袁振山 [1] 孙肖阳 [1]
第一作者: 胡勇
期刊: 《中华外科杂志》2014年52卷9期 686-691页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2014.09.013
发布时间: 2014-09-25
基金项目:
浙江省自然科学基金资助项目
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