摘要目的 探讨在无法做正位透视监测的情况下,后路寰枢侧块钉板固定术中在寰椎侧块置钉的准确性.方法 术中探查寰椎侧块内缘、间接确定寰椎侧块螺钉穿刺点.收集已行寰枢椎侧块钉板固定术的159例患者的术后CT,从冠状位和轴位CT,观察记录螺钉在寰椎侧块内的位置.在寰椎的CT轴位像上将侧块分为3个区域:A区相当于寰椎侧块上关节面投影区,螺钉在此区域内固定强度最可靠;B区位于上关节面投影区周缘的骨质内(B1内侧,B2外侧),螺钉在此区域内固定强度不可靠;C区位于侧块以外(C1椎管内,C2横突孔内),固定依赖于寰椎前弓或寰椎横突,稳定性较差,且有可能损伤脊髓或椎动脉.结果 159例患者共置入螺钉318枚,其中308枚位于A区,占96.9%;3枚位于B1区,2枚位于B2区,占1.6%;5枚位于C1区,占1.6%.所有患者在术后4个月随访时寰枢椎后弓间植骨都已融合.结论 术中通过探查寰椎侧块内缘、间接确定螺钉穿刺点的方法 可准确地将螺钉置入寰椎侧块.

abstractsObjective To evaluate the veracity of the C1 lateral mass screw insertion in the atlarttoaxial fixation using plate and screw method without A-P fluoroscopic guiding.Methods In the atlantoaxial fixation,without A-P fluoroscopic guiding,we probe lateral mass edge and identify the entrance point of C1 lateral mass screw indirectly.159 patients treated with atlantoaxial fixation using plate and screw method were studied.Postoperative CT was used for analysis,and the position of the lateral mass screws in atlas was identified by coronary and axial CT scan.Three areas were delimitated in and around the lateral mass of atlas in the axial CT scan,so as to analyze the location of screws:area A(inside the ioint face),area B(outside the ioint face but still in lateral mass),and area C(outside the lateral mass).Results Among the 318 screws,308(96.9%)were located in area A,5 in area B(1.6%),and 5 in area C (1.6%).All cases got atlantoaxial union at 4 months after operation.Conclusion Probing lateral mass edge and identifying the lateral mass indirectly is reliable for identifying the path of screw in arias.