摘要
目的明确后路经寰枕关节螺钉固定的技术参数,为临床治疗提供参考。方法20具包含完整寰枕关节的干燥骨标本,于直视下经寰枕关节置入克氏针固定后拍摄X线片,在X线片上测量经寰枕关节螺钉固定的螺钉角度和长度。对30名健康成年人的寰枕关节行三维CT重建,测量后路经寰枕关节螺钉内固定螺钉角度的可调范围。对12具新鲜枕颈部标本行后路枕寰枢经关节螺钉内固定,然后拍摄X线片并行三维CT重建,以明确螺钉位置。结果经寰枕关节固定螺钉方向在矢状面呈上倾,冠状面呈内倾,左右两侧略有不同,但差异无统计学意义(P>0.05)。后路经寰枕关节螺钉固定的理想角度在矢状面的上倾角为53.3°±3.4°,在冠状面的内倾角为20.0°±2.6°,钉道长度为(29.28±2.46)mm。三维CT重建显示上倾角的可调范围为24.9°～74.6°,内倾角的可调范围为0.7°～40.5°。在新鲜标本上按照上述角度进行后路枕寰枢经关节螺钉内固定,影像学检查结果显示,螺钉钉道均经过寰枕关节,无进入神经管者。结论后路经寰枕关节螺钉固定时对准确性要求较高,结合后路C1,2经关节螺钉固定可视为能满足当前临床需要的一种较好的枕颈融合方法。
Objective Explicit the technical parameters in posterior atlanto-occipital transarticular screw fixation; discuss the clinic significance of craniovertebral junction fixation with transarticular screws. Methods Posterior atlanto-occipital transarticular K-pin implantation was performed under visual control on 20 dried bony specimens that contained complete atlanto-occipital articulations. Then the angle and length of the atlanto-occipital transarticular screw trajectory were measured on the cephalocaudal and lateral X-ray filems. The atlanto-occipital articulations of 30 normal adult Chinese were three-dimensionally recon- structed by CT, on which the adjustable range of allowable angle of the posterior atlanto-occipital transarticular screw trajectory were measured. On 12 fresh craniovertebral junction specimens, posterior occipitoatlantoaxial transarticular screw fixation was performed. Roentgen rays were examined, and three-dimensional CT was reconstructed postoperatively to study the positions of screws. Results The atlanto-occipital transarticular screw trajectory was placed cephalad tilting in sagittal plane and medial tilting in coronary plane. There was little differences between leftside and rightside, but without significence（P〉0.05）. The ideally placed angles of the screws were 53.3°±3.4° upper tilting in sagittal plane and 20.0°±2.6° inside tilting in coronary plane. The ideal length of the trajectory was （29.28°±2.46） mm. The allowable range for adjusting the direction of the trajectory was 24.9°-74.6° on sagittal plane, and 0.7°-40.5° on coronary plane. Imageological examination on fresh specimens demonstrated that atlanto-occipital transarticular screw fixation ac- cording the above results ensured insertion of the trajectory passing through the atlanto-occipital articulation without running the risk of going into the neural tube. Conclusion Posterior atlano-occipital transarticular fixation is clinical feasible; but there are some directions for implantating the screws. When
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第1期35-38,共4页
Chinese Journal of Orthopaedics
关键词
寰枕关节
内固定器
解剖学
Atlanto-occipital joint
Internal fixators
Anatomy
