中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
12期
1337-1343
,共7页
徐荣明%赵刘军%马维虎%朱彦昭
徐榮明%趙劉軍%馬維虎%硃彥昭
서영명%조류군%마유호%주언소
颈椎%脊柱融合术%内固定器%解剖学
頸椎%脊柱融閤術%內固定器%解剖學
경추%척주융합술%내고정기%해부학
Cervical vertebrae%Spinal fusion%Internal fixators%Anatomy
目的 通过解剖学测量和临床应用,探讨下颈椎前路椎弓根螺钉置入的可行性、安全性及其临床疗效.方法 对20具成人颈椎标本通过CT扫描后进行数据测量,内容包括:椎体高度、椎体前后径、椎体宽度、椎弓根横径、椎弓根高度、螺钉长度、横切面角度、矢状面角度、横切面进针点距离、矢状面进针点距离,确定进针点,并进行尸体标本置钉.根据测量数据和术前影像学检查对5例颈椎骨折脱位患者行下颈椎前路椎弓根螺钉固定植骨融合术,术后观察复位及螺钉位置情况及短期随访结果.结果 横切面角度从C3(45.7°4.0°)至C5 (52.1°±5.9°)逐渐增大,至C6(47.8°±6.7°)、C7(44.4°±8.3°)又有所减小.矢状面角度从C3(93.4°±7.2°)至Cd112.1°±6.2°)逐渐增大,至C7(102.7°±8.5°)又有所减小.横切面进针点C3～C5位于椎弓根对侧,C6～C7位于椎弓根同侧；矢状面进针点距离3.4～7.5 mm.5例患者术中减压彻底,螺钉均位于椎弓根钉道内,日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)均有不同程度地提高.结论 下颈椎前路椎弓根螺钉的理想进针点位于距上终板5 mm左右,椎体前正中线附近.横切面角度约为45.7°～52.1°,矢状面角度约为93.4°～112.1°.螺钉长度约为32 mm.
目的 通過解剖學測量和臨床應用,探討下頸椎前路椎弓根螺釘置入的可行性、安全性及其臨床療效.方法 對20具成人頸椎標本通過CT掃描後進行數據測量,內容包括:椎體高度、椎體前後徑、椎體寬度、椎弓根橫徑、椎弓根高度、螺釘長度、橫切麵角度、矢狀麵角度、橫切麵進針點距離、矢狀麵進針點距離,確定進針點,併進行尸體標本置釘.根據測量數據和術前影像學檢查對5例頸椎骨摺脫位患者行下頸椎前路椎弓根螺釘固定植骨融閤術,術後觀察複位及螺釘位置情況及短期隨訪結果.結果 橫切麵角度從C3(45.7°4.0°)至C5 (52.1°±5.9°)逐漸增大,至C6(47.8°±6.7°)、C7(44.4°±8.3°)又有所減小.矢狀麵角度從C3(93.4°±7.2°)至Cd112.1°±6.2°)逐漸增大,至C7(102.7°±8.5°)又有所減小.橫切麵進針點C3～C5位于椎弓根對側,C6～C7位于椎弓根同側；矢狀麵進針點距離3.4～7.5 mm.5例患者術中減壓徹底,螺釘均位于椎弓根釘道內,日本骨科協會評分(Japanese Orthopaedic Association Scores,JOA)均有不同程度地提高.結論 下頸椎前路椎弓根螺釘的理想進針點位于距上終闆5 mm左右,椎體前正中線附近.橫切麵角度約為45.7°～52.1°,矢狀麵角度約為93.4°～112.1°.螺釘長度約為32 mm.
목적 통과해부학측량화림상응용,탐토하경추전로추궁근라정치입적가행성、안전성급기림상료효.방법 대20구성인경추표본통과CT소묘후진행수거측량,내용포괄:추체고도、추체전후경、추체관도、추궁근횡경、추궁근고도、라정장도、횡절면각도、시상면각도、횡절면진침점거리、시상면진침점거리,학정진침점,병진행시체표본치정.근거측량수거화술전영상학검사대5례경추골절탈위환자행하경추전로추궁근라정고정식골융합술,술후관찰복위급라정위치정황급단기수방결과.결과 횡절면각도종C3(45.7°4.0°)지C5 (52.1°±5.9°)축점증대,지C6(47.8°±6.7°)、C7(44.4°±8.3°)우유소감소.시상면각도종C3(93.4°±7.2°)지Cd112.1°±6.2°)축점증대,지C7(102.7°±8.5°)우유소감소.횡절면진침점C3～C5위우추궁근대측,C6～C7위우추궁근동측；시상면진침점거리3.4～7.5 mm.5례환자술중감압철저,라정균위우추궁근정도내,일본골과협회평분(Japanese Orthopaedic Association Scores,JOA)균유불동정도지제고.결론 하경추전로추궁근라정적이상진침점위우거상종판5 mm좌우,추체전정중선부근.횡절면각도약위45.7°～52.1°,시상면각도약위93.4°～112.1°.라정장도약위32 mm.
Objective To investigate application of the anterior cervical pedicle screw in the lower cervical spine.Methods Twenty disarticulated human vertebrae (C3-C7) were evaluated with computed tomography for pedicle morphometry Parameters included vertebral body height,vertebral body depth,vertebral body width,outer pedicle width,outer pedicle height,pedicle axis length,transverse section angle,sagittal section angle,transverse intersection point distance and sagittal intersection point distance.On the basis of these data,the screw channel was determined and the screws were inserted in the specimen.Five patients underwent surgical reconstruction using anterior pedicle screw fixation.After surgery,physical examination and roentgenograms and CT scans were performed in all patients.Results The transverse section angle increased from C3(45.7°±4.0°) to C5(52.1°±5.9° ),but decreased from C6(47.8°±6.7°) to C7(44.4°± 8.3°).The sagittal section angle gradually increased from C3 (93.4°±7.2°) to C6( 112.1°±6.2°) but decreased a little to C7(102.7°±8.5°).The distances in transverse section was about 1.97-3.98 mm and in sagittal section was 3.4-7.5 mm.Anterior pedicle screws were inserted successfully in all specimens without critical pedicle wall perforations.Patients were permitted to ambulate the next day after surgery with a cervical collar.Postoperative neurological improvement was observed in all cases.Postoperative radiographic evaluation confirmed proper insertion of anterior pedicle screws without pedicle perforaton.The average follow-up time was 10.6 months.No anterior pedicle screw breakage and loosening was observed.Conclusion The entry point in anterior pedicle screw should located in 5mm to upper endplate and near anterior median line.The transverse section angle should be 45.7°-52.1°and the sagittal section angle should be 93.4°-112.1°.The lengths of the screw should be about 32 mm.
