CAJ | 학술논문

背景：寰椎侧块螺钉固定技术按其入钉点的不同可分为寰椎后弓下侧块螺钉固定和经寰椎后弓侧块螺钉固定(又称寰椎椎弓根螺钉固定)，这2种固定方法各有优缺点，以往缺乏关于2种寰椎侧块螺钉固定方法骨性解剖可行性的比较研究， 　　目的：以测量国人寰椎相关骨性解剖数据为依据，比较2种寰椎侧块螺钉固定方法的可行性。 　　方法：收集30例(60侧)成人颈椎病患者的寰椎螺旋CT扫描数据，利用CT工作站对数据重建，分别测量寰椎侧块螺钉固定的关键骨性解剖数据，适合行经寰椎后弓侧块螺钉固定的标准为寰椎椎动脉沟处后弓高度和宽度≥4 mm；适合行经寰椎后弓下侧块螺钉固定的标准为寰椎后弓下侧块高度≥4 mm。 　　结果与结论：寰椎椎动脉沟处后弓高度为(4.54±1.17) mm，椎动脉沟处后弓宽度为(8.69±1.12) mm，寰椎后弓下侧块高度为(4.98±1.07) mm。寰椎后弓椎动脉沟高度大于4 mm(适合经寰椎后弓螺钉固定组)有41侧，占68%；寰椎后弓下侧块高度大于4 mm(适合经寰椎后弓下侧块螺钉固定)有52侧，占87%，2组差异有显著性意义(P<0.05)。提示经寰椎后弓下侧块螺钉固定较经寰椎椎弓根螺钉更具可行性。术前利用CT测量寰椎关键解剖结构数据对制定个性化手术方案具有重要意义。
배경：환추측괴라정고정기술안기입정점적불동가분위환추후궁하측괴라정고정화경환추후궁측괴라정고정(우칭환추추궁근라정고정)，저2충고정방법각유우결점，이왕결핍관우2충환추측괴라정고정방법골성해부가행성적비교연구， 　　목적：이측량국인환추상관골성해부수거위의거，비교2충환추측괴라정고정방법적가행성。 　　방법：수집30례(60측)성인경추병환자적환추라선CT소묘수거，이용CT공작참대수거중건，분별측량환추측괴라정고정적관건골성해부수거，괄합행경환추후궁측괴라정고정적표준위환추추동맥구처후궁고도화관도≥4 mm；괄합행경환추후궁하측괴라정고정적표준위환추후궁하측괴고도≥4 mm。 　　결과여결론：환추추동맥구처후궁고도위(4.54±1.17) mm，추동맥구처후궁관도위(8.69±1.12) mm，환추후궁하측괴고도위(4.98±1.07) mm。환추후궁추동맥구고도대우4 mm(괄합경환추후궁라정고정조)유41측，점68%；환추후궁하측괴고도대우4 mm(괄합경환추후궁하측괴라정고정)유52측，점87%，2조차이유현저성의의(P<0.05)。제시경환추후궁하측괴라정고정교경환추추궁근라정경구가행성。술전이용CT측량환추관건해부결구수거대제정개성화수술방안구유중요의의。
BACKGROUND:Atlantal lateral mass screw fixation contains lateral mass screw fixation under the posterior arch of the atlas and lateral mass screw fixation via the posterior arch of atlas (also cal ed atlas pedicle screw fixation) according to different insertion points. The two methods have their advantages and disadvantages. There are lacks of the comparative studies on bony anatomy feasibility by two kinds of atlantal lateral mass screw fixation. OBJECTIVE:To compare the feasibility associated with two kinds of atlantal lateral mass screw fixations taking Chinese data of atlantal bony anatomy as evidence. METHODS:Data of CT scans in 30 adults with cervical spondylosis (60 sides) were col ected, and data were reconstructed using CT workstation. We measured key bone anatomy structure after atlantal lateral mass screw fixation. The atlantal lateral mass was suitable for lateral mass screw fixation via the posterior arch of atlas if its height and width of vertebral artery groove at the posterior arch ≥ 4 mm. It was suitable for lateral mass screw fixation under the posterior arch of the atlas if the height of posterior arch of atlas lateral mass ≥ 4 mm. RESULTS AND CONCLUSION:The height of vertebral artery groove at the posterior arch was (4.54±1.17) mm. The width of vertebral artery groove at the posterior arch was (8.69±1.12) mm. The height of posterior arch of atlas lateral mass was (4.98±1.07) mm. There were 41 cases with the height of vertebral artery groove at the posterior arch>4 mm (suitable for lateral mass screw fixation via the posterior arch of atlas, occupying 68%. There were 52 cases with the height of posterior arch of atlas lateral mass>4 mm (suitable for lateral mass screw fixation under the posterior arch of the atlas), occupying 87%. There were significant differences in the differences between the two groups (P<0.05). These results indicated that lateral mass screw fixation under the posterior arch of the atlas was more feasible compared with lateral mass screw fixation via the posterior arch of atlas. Preoperative CT measure for key anatomic structure was significant for making personalized surgical plan.