CAJ | 학술논문

目的通过解剖学测量,探讨经寰椎后弓螺钉固定重建上颈椎稳定性的解剖学基础.方法测量39具干燥寰椎标本椎管内径宽度、螺钉进钉点后弓高度和宽度、寰椎椎动脉沟底后弓高度和宽度、经后弓螺钉固定钉道长度和侧块钉道长度、后弓固定与侧块固定进钉角度等解剖学数据.统计学分析所测量数据并对经寰椎后弓螺钉固定钉道长度与经侧块螺钉固定钉道长度两组数据配对student t检验,检验水准为α=0.05.结果寰椎椎管内径宽度为(26.80±2.58)mm;进钉点寰椎后弓高度和宽度分别为(6.83±1.97)mm和(6.40±1.36)mm;椎动脉沟底后弓高度和宽度分别为(4.37±1.11)mm和(8.05±1.33)mm;经后弓螺钉固定钉道长度为(30.54±1.70)mm.进钉点置钉时钉道外倾角度为15°～20°、吻侧前倾角度为0°～5°.椎动脉沟底骨质高度小于颈椎常用螺钉直径3.5 mm的占25.6%(10具).经侧块螺钉固定钉道长度为(16.91±1.13)mm,进钉点置钉时钉道内倾角度为32.05°±6.03°、头侧前倾角度为5°.经后弓螺钉固定钉道长度与经侧块钉道长度两组数据配对student t检验统计分析结果显示差异有统计学意义(t=59.528,P＜0.001).结论约有74.4%的人群可顺利经寰椎后弓螺钉固定完成上颈椎稳定性的重建,该技术不仅可使寰椎得到即刻、牢靠的稳定性,同时较寰椎经侧块螺钉固定技术具有较小的手术风险和操作难度,是一项具有推广价值的寰椎稳定技术.
목적 통과해부학측량,탐토경환추후궁라정고정중건상경추은정성적해부학기출.방법 측량39구간조환추표본추관내경관도、라정진정점후궁고도화관도、환추추동맥구저후궁고도화관도、경후궁라정고정정도장도화측괴정도장도、후궁고정여측괴고정진정각도등해부학수거.통계학분석소측량수거병대경환추후궁라정고정정도장도여경측괴라정고정정도장도량조수거배대student t검험,검험수준위α=0.05.결과 환추추관내경관도위(26.80±2.58)mm;진정점환추후궁고도화관도분별위(6.83±1.97)mm화(6.40±1.36)mm;추동맥구저후궁고도화관도분별위(4.37±1.11)mm화(8.05±1.33)mm;경후궁라정고정정도장도위(30.54±1.70)mm.진정점치정시정도외경각도위15°～20°、문측전경각도위0°～5°.추동맥구저골질고도소우경추상용라정직경3.5 mm적점25.6%(10구).경측괴라정고정정도장도위(16.91±1.13)mm,진정점치정시정도내경각도위32.05°±6.03°、두측전경각도위5°.경후궁라정고정정도장도여경측괴정도장도량조수거배대student t검험통계분석결과현시차이유통계학의의(t=59.528,P＜0.001).결론 약유74.4%적인군가순리경환추후궁라정고정완성상경추은정성적중건,해기술불부가사환추득도즉각、뢰고적은정성,동시교환추경측괴라정고정기술구유교소적수술풍험화조작난도,시일항구유추엄개치적환추은정기술.
Objective To investigate the anatomy of upper cervical vertebrae's stable reconstruction by poster arch of atlas screw by anatomic study. Methods To collect the anatomical data of 39 dry atlas with the average inner diameter of vessel of atlas, the average high and wide of the screw point of poster arch of atlas, the average high and wide of poster arch of atlas beneath the groove for vertebral artery, the tract length of poster arch screw, the tract length of lateral mass screw, the direction and angle of poster arch screw, and the direction and angle of lateral mass. Statistical comparison were performed with Student test between the tract length of poster arch screw and the tract length of lateral mass screw. Results The average inner diameter of vessel of atlas was (26.8±2.58) mm(21.7-31.0 mm). The screw point high and wide of poster arch of atlas were (6.83±1.97) mm and (6.40±1.36) mm respectively. The average high and wide of poster arch of atlas beneath the groove for vertebral artery were (4.37±1.11) mm and (8.05±1.33) mm respectively. The tract length of poster arch screw were (30.54±1.705) mm. The direction and angle of poster arch screw was 15°-20° incline laterally and 0°-5°incline cephalo. 25.6%(10 cases) patients with the diameter less than 3.5mm beneath the groove for vertebral artery. The direction and angle of lateral mass screw was 32.05°±6.03° incline medially and 5° incline cephalo. There were significant differences between the tract length of poster arch screw and the tract length of lateral mass screw(t=59.528, P＜0.001 ). Conclusion About 74.4% patients can reconstruct the upper cervical stable by poster arch of atlas screw. The technique can gain instant upper cervical stable, and reduce the risk of injury of blood vessel by over explore the atlas arch compare with the technique of lateral mass screw fixation of atlas. The technique is worth to promoting with its character of safe, easy perform and rigid fixation.