枕骨螺钉内固定的应用解剖

Applied Anatomy of Internal Fixation of Occipital Bone Screw

目的 为枕骨螺钉内固定螺钉的选择提供解剖学依据。方法 测量50块干燥完整的成人枕骨后下部的骨质厚度。在30例成人头颈部标本上测量窦汇和横窦的体表投影，在10例成人头颈部标本上分别作水平切面和矢状切面观测枕骨的骨质构造。结果 枕骨后下部的骨质厚薄不一，但左右两侧基本对称，无明显差异，测量区最厚处位于枕外隆凸，为15．50±2．59（12．91～18．09）mm，最薄处大致位于小脑窝，为2．64±1．44（1．20～4．08）mm，骨质厚度大于8mm的区域为EOP线与H2、H4线的相交点及H线与L、R线的相交点这四点相连所围成的菱形区域。窦汇的体表投影与枕外隆凸基本一致，左侧横窦主要位于上项线稍下方，右侧横窦主要位于上项线水平。窦汇和横窦大致位于枕骨骨质厚度大于8mmm的菱形区域的深面。枕骨主要为致密的皮质骨。结论 枕骨螺钉内固定于枕骨的安全区域应选择在枕骨骨质厚度大于8mm的菱形区域。

Objective To provide anatomy basis for the choice of screw in the internal fixation. Methods The thickness of the decocted later part of occipital bone was measured on fifty dry adult skulls. The projections of confluence sinuum and transverse sinus were measured on thirty adult craniocervical specimens. And the construction of occipital bone was observed on horizontal section and sagittal section of ten adult craniocervical specimens. Results The occipital thickness was irregular, but there was no distinct difference between the left and right sides. The external occipital protuberance was the thickest place, which was 15.50± 2.59（ 12.91 - 18.09）mm. The cerebellar fossa was the thinnest place, which was 2.64 ± 1.44（ 1.20- 4.08）mm. The area where the thickness was beyond 8 mm was a rhombus region. The body surface project of confluence sinuum coincided with external occipital protuberance basically. Most of left transverse sinus were slightly lower to the superior nuchal line. The majority, of tight transverse sinus were located in the superior nuchal line. The bone covered confluence sinuum and transverse sinus was thicker than 8 ram. Occipital bone comprises compact os integumentale. Conclusion The safe operation area is the rhombus region where the thickness is thicker than 8 mm.