摘要
目的明确下颈椎后路经关节螺钉固定的技术参数，为临床应用提供参考。方法取20具（男14具、女6具）尸体颈椎标本，仔细解剖颈部的后侧和侧前方，以清晰地暴露颈椎侧块，保护好脊神经前、后支（C2-7）及其与周围结构的关系。确定安全的进、出钉点，从C2.3-C5.6直视下置人经关节螺钉。通过CT重建，测量经关节固定螺钉的角度、长度、螺钉尖与椎动脉的距离，并确定经关节螺钉矢状面的安全进钉角度（sagittal safety angle，SSA）。结果经关节固定螺钉方向在矢状面呈尾倾，冠状面呈外倾，各固定节段间略有不同，但差异无统计学意义（P〉0．05）。下颈椎后路经关节螺钉固定的理想角度为在矢状面尾倾平均37.3^o±5．0^o，在冠状面外倾平均16．6^o±4．6^o。经关节螺钉钉道长度平均为（18．7±1.4）mm，在C2.3，水平螺钉钉道长度与C3.4C4.5C5.6比较差异有统计学意义（P〈0．05）。后路经关节螺钉矢状面安全进钉角度为41．9^o±5．6^o，螺钉钉尖与椎动脉的距离平均为（5．8＋1．5）mm，各固定节段间略有不同，但差异无统计学意义（P〉0．05）。结论下颈椎后路经关节螺钉置钉时要求一定的准确性，可以作为颈椎侧块螺钉和椎弓根螺钉固定的一种补充内固定方法。
Objective To identify the technical parameters of posterior transarticular screw fixation in lower cervical spine and provide the references for the clinical application. Methods Twenty cadaveric cervical spines （including 14 males and 6 females） involved in this study, and the posterior and lateralposterior stractures were carefully dissected to expose the lateral mass. To preserve the nerve roots （C2-C7） and their anatomic relationship to surrounding structures. After the safe entrance and the ideal exit point of transarticular screws were determined, posterior transarticular screws implantation was performed under visual control from C2.3 to C5.6. Then a CT was done. On the morphologic CT scan, the angle and length of the transarticular screw trajectory, the distance between the tip of the screw and the vertebral artery and the sagittal safety angle （SSA） were measured. Results The cervical transarticular screw trajectory, the distance between the tip of the screw and the SSA were caudal tilting in the sagittal plane and lateral tilting in the axial plane. There was little differences between different number of cervical vertebrae, but without significance（P〉0.05）. The ideally placed angles of the screws were 37.3^o± 5.0^o caudal tilting in the sagittal plane and 16.6^o±4.6^o lateral tilting in the axial plane. The ideal length of the trajectory was （18.7＋1.4） mm. There was significant difference statistically between C 2.3 and C 3.4 -C 2.6 （P〈0.05）. The SSA was 41.9^o＋5.6^o, and the distance between the tip of the screw was （5.8＋1.5）mm. There were a little differences of SSA and the distance in the different cervical fixation level, but without statistical significance （P〉0.05）. Conclusion Posterior transarticular screw fixation is clinical feasible, and there are some directions for implantating the screws, transarticular fixation in the lower cervical spine affords an alternative to standard screw placement for plate fixation and cervical stabilization.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第9期677-681,共5页
Chinese Journal of Orthopaedics
基金
浙江省医药卫生科学研究基金资助项目（20078201）,宁波市社会发展攻关项目（2006C100061）
关键词
颈椎
内固定器
解剖学
局部
Cervical vertebrae
Internal fixators
Anatomy, regional
