CAJ | 학술논문

目的研究寰椎后弓交叉螺钉固定的解剖学可行性,以提供可供选择的寰椎固定方法.方法对10具寰椎标本进行实体测量和CT测量.测量指标包括后结节高度、后弓的宽度、从理想入钉点到椎动脉沟内缘的距离、入钉点到后结节的距离及理想的钉道角度,比较两种方法测量结果的统计学差异.再对100张寰椎三维CT片进行测量,测量指标有后结节(后弓中点矢状面垂直距离)高度、后弓的宽度(水平面后弓与椎动脉沟移行处内侧)、从理想入钉点到椎动脉沟内缘(螺钉完全位于髓腔内)的距离、理想入钉点到后结节的距离及理想钉道的角度(理想钉道与水平线夹角),分析寰椎的解剖学特点.计算后结节高度＞7 mm,后弓宽度＞3.5 mm及无法对侧置钉的比例.结果寰椎标本的实体测量和CT测量的结果差异无统计学意义.100张寰椎三维CT经测量,椎板后弓的宽度:左侧为(4.7±0.9)mm,右侧为(4.6±0.8)mm; 93.5％( 187/200)宽度＞3.5 mm.从理想的入钉点到椎动脉沟内侧缘的髓腔距离(理想螺钉长度):左侧为(15.9±3.0) mm,右侧为(15.9±3.0) mm,提示螺钉的长度可超过15 mm.后结节的高度值为(7.8±1.2) mm,91％(91/100)高度＞7 mm.理想钉道的角度:左侧为26.8°±6.8°(8°～44°),右侧为26.8°±6.3°(13°～44°),11％(22/200)无法交叉置钉.结论解剖学和影像学研究提示寰椎后弓交叉螺钉技术是安全有效的固定方法,为寰椎后路固定提供选择.
목적 연구환추후궁교차라정고정적해부학가행성,이제공가공선택적환추고정방법.방법 대10구환추표본진행실체측량화CT측량.측량지표포괄후결절고도、후궁적관도、종이상입정점도추동맥구내연적거리、입정점도후결절적거리급이상적정도각도,비교량충방법측량결과적통계학차이.재대100장환추삼유CT편진행측량,측량지표유후결절(후궁중점시상면수직거리)고도、후궁적관도(수평면후궁여추동맥구이행처내측)、종이상입정점도추동맥구내연(라정완전위우수강내)적거리、이상입정점도후결절적거리급이상정도적각도(이상정도여수평선협각),분석환추적해부학특점.계산후결절고도＞7 mm,후궁관도＞3.5 mm급무법대측치정적비례.결과 환추표본적실체측량화CT측량적결과차이무통계학의의.100장환추삼유CT경측량,추판후궁적관도:좌측위(4.7±0.9)mm,우측위(4.6±0.8)mm; 93.5％( 187/200)관도＞3.5 mm.종이상적입정점도추동맥구내측연적수강거리(이상라정장도):좌측위(15.9±3.0) mm,우측위(15.9±3.0) mm,제시라정적장도가초과15 mm.후결절적고도치위(7.8±1.2) mm,91％(91/100)고도＞7 mm.이상정도적각도:좌측위26.8°±6.8°(8°～44°),우측위26.8°±6.3°(13°～44°),11％(22/200)무법교차치정.결론 해부학화영상학연구제시환추후궁교차라정기술시안전유효적고정방법,위환추후로고정제공선택.
Objective To identify the anatomical feasibility of cross screw fixation in the atlas via posterior arch,provide a reference for clinical applications.Methods A total of 10 dry atlas specimens were used to measure anatomic data and three dimension(3D) CT data.The data included height of the posterior tubercle,width of the posterior arch,distance from the ideal point to the interior of the vertebral artery sulcus,from nail point to central line,and the ideal direction of the screws.Statistical analysis was done to compare the two methods.Then 100 3D CT data were measured.The parameters included height of the posterior tubercle (mid-sagittal plane),width of the posterior arch (the inner side where arch transformed to the vertebral artery sulcus),distance from the ideal point to the interior of the vertebral artery sulcus (where screws completely located in the medullary cavity),distance between the nail point to central line,and angle of the ideal screws (between screws and horizontal line).The anatomy of the atlas was analyzed for whether height of the posterior tubercle is more than 7 mm,width of the posterior arch is more than 3.5 mm,and whether or not cross screws can be planted.Results There was no statistical difference between anatomic and 3D-CT measures.Thickness of the C1 laminar was (4.7±0.9) mm in the left side,(4.6±0.8) mm in the right side,and 93.5％ of specimens were thicker than 3.5 mm.Distance of the "ideal screw" was (15.9±3.0) mm in the left side,(15.9±3.0) mm in the right side.Height of the C1 posterior tuber was (7.8±1.2) mm,with 91％ of the data higher than 7.0 mm.Angle between the axial of C1 laminar and frontal plane was 26.8°±6.8° (8°-44°) in the left side,26.8°±6.3°(13°-44°) in the right side,and about 11％ of them can not cross plant.Conclusion It is feasible and safe to place cross screws in the posterior arch of the C1 in anatomy.