枢椎后路棘突螺钉固定技术及其解剖学研究
刘观燚n;徐荣明;马维虎;孙韶华;冯建翔;胡勇;赵刘军;周雷杰
【期刊名称】《中华外科杂志》 【年(卷),期】2010(048)021
【摘要】目的 明确枢椎后路棘突螺钉固定的解剖学可行性和技术参数,为临床应用提供参考.方法 选取30具枢椎标本,仔细解剖以清楚地暴露椎板和棘突.测量枢椎棘突根部1/2的中点、中部和后部1/2的中点高度;棘突根部的头侧1/2的中点、中部和根部的尾侧1/2的中点厚度(精确到0.01 mm).选取20具枢椎标本,以棘突基底部为进钉点,双侧平行置入棘突螺钉,通过CT重建,测量棘突的宽度、螺钉进钉角度、钉道长度及钉尖与脊髓、椎动脉的距离.结果 枢椎棘突平均高度和厚度各自为(12.90±1.30)mm和(18.86±1.17)mm.所有棘突螺钉均成功置入枢椎棘突,未见螺钉侵犯椎管、横突孔和棘突劈裂.重建CT测量棘突中份基底部的平均宽度为(20.7±1. 3)mm;棘突螺钉在横断面的前倾角度为1.8°±1.0°,在横断面上和矢状面上几乎均是平行.螺钉钉道长度为(19.7±1. 1)mm,螺钉钉尖与椎动脉距离为(20.2±3.1)mm,螺钉钉尖与脊髓距离为(8.3±2.6)mm,上下位左右侧螺钉角度与椎动脉和脊髓的距离数据略有不同,但差异无统计学意义(P＞0.05),但上位螺钉钉道长度(18.4±1.1)mm明显短于下位螺钉钉道长度(20.3±1.2)mm,差异有统计学意义(t=3.566,P＜0.01).结论 枢椎后路棘突螺钉具有一定的解剖学可行性,也许可以作为枢椎后路固定的一种补充内固定方法,但临床应用之前,尚需进一步的生物力学研究.%Objectives To quantitatively anatomically evaluate the C2 spinous process, analyze the anatomical feasibility of the C2 spinous process screws and its clinical significance.
Methods To dissect and evaluate 30 cervical cadaveric spines of C2 which were taken to expose the lamina and spinous process. Anatomic quantitative evaluation of the C2 spinous process included its height and width. Twenty cervical cadaveric spines of C2 were chosen to the study of the placement of the C2 spinous process screws. The starting point for the C2 spinous process screw insertion was located at the base of the spinous process. After the entrance point of spinous process screws was determined, posterior C2 spinous process screw implantation was performed bilaterally under direct visualization. On the morphologic CT scan, the width of C2 spinous process base, the angle and length of the spinous process screw trajectory, and the distance between the tip of the screw and the spinal cord and the vertebral artery were measured. Results The average height and width of the C2 spinous process were ( 12.90 ± 1.30) mm and( 18. 86 ± 1.17) mm respectively. The C2 spinous process screws were successfully placed without impingement the spinal cord or the vertebral artery and the breakage of the spinous process. On the CT scan, the average width of the base of C2 spinous process was (20. 7 ± 1.3) mm. The placed angles of the screws were 1.8°± 1.0° in the axial plane. The distance between the tip of the screw and the spinal cord or the vertebral artery was ( 8. 3 ± 2. 6 )mm and ( 20. 2 ± 3. 1 ) mm respectively. There were little differences between superior and inferior screws in the angle,the
distance between the tip of the screw and the spinal cord or the vertebral artery, but without significance(P ＞0.05). The average trajectory length of the C2 spinous process screws was (19. 7 ± 1.1 )mm. The average trajectory length of the superior spinous process screws was shorter than that of inferior spinous process screws, with great differences ( t = 3. 566, P ＜ 0. 01 ). Conclusions There is the anatomic feasibility of the C2 spinous process screw fixation which may afford an alternative to standard screw placement for axis fixation. The biomechanical study for the C2 spinous process screw is also necessary. 【总页数】4页(1653-1656)
【关键词】枢椎;内固定器;解剖学;棘突螺钉
【作者】刘观燚n;徐荣明;马维虎;孙韶华;冯建翔;胡勇;赵刘军;周雷杰
【作者单位】315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科;315040,浙江省宁波市第六医院骨科 【正文语种】中文 【中图分类】R6 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-surgery_thesis/0201234890817.html 【相关文献】
枢椎后路棘突螺钉固定技术及其解剖学研究
