国人寰椎定量解剖研究及螺钉置入的安全性探讨

Quantitative anatomic study and investigation of screw placement safety in Chinese atlas

目的:观察和测量国人寰椎以获取形态学参数,为临床治疗提供科学证据,减少相关手术并发症。方法:用电子游标卡尺和量角器测量48套正常成年人寰椎新鲜标本的相关参数,包括寰椎前弓宽度(AW)、寰椎前弓与侧块相连处厚度(AD)、后弓椎动脉沟最窄处骨内的高度(ITG)、后弓椎动脉沟最窄处外缘的高度(OTG)、侧块中点高度(MHL)和侧块宽度(LW)、寰椎侧块外倾角(α),并进行统计学分析。结果:AW平均为(20.45±1.53)mm;AD男性左侧平均为(3.91±1.32)mm,右侧平均为(4.11±1.42)mm,女性左侧平均为(3.72±1.61)mm,右侧平均为(3.82±1.53)mm;ITG男性左侧平均为(2.46±1.57)mm,右侧平均为(2.41±1.65)mm,女性左侧平均为(2.36±1.57)mm,右侧平均为(2.32±1.65)mm;OTG男性左侧平均为(4.76±2.26)mm,右侧平均为(4.64±1.70)mm,女性左侧平均为(4.55±2.26)mm,右侧平均为(4.53±1.30)mm;MHL平均为13.68mm;LW平均为12.98mm;α平均为25°。结论:手术时必须考虑到个体、性别、左右差异。术中禁忌盲目操作以免造成椎动脉、神经根及脊髓损伤。由于寰椎椎弓根螺钉和寰椎侧块螺钉进钉点不同,使得寰椎椎弓根螺钉的长度较寰椎侧块螺钉要长。

Objective：To observe and measure Chinese atlas specimen to obtain morphological parameter,in order to provid scientific evidence for clinical treatment and to reduce operative complication.Methods：The relative parameters of 48 sets of fresh Chinese adults＇ atlas specimens were measured with a digital caliper and a goniometer,including the width of anterior arch of atlas（AW）,the thickness of atlas at the junction of anterior arch and lateral mass（AD）,the inner thickness in the coronal plane of the posterior arch at the thinnest part of the vertebral artery groove（ITG）,the outer thickness in the coronal plane of the posterior arch at the thinnest part of the vertebral artery groove（OTG）,the middle height and width of the lateral mass（MHL and LW respectively） and the extraversion angle of lateral mass of atlas（α°）.The data were statistically analyzed.Results：The width of anterior arch of atlas（AW） was（20.45±1.53） mm.The thickness of atlas at the junction of anterior arch and lateral mass（AD） was（3.91±1.32） mm,（4.11±1.42） mm,（3.72±1.61） mm and（3.82±1.53） mm respectively on left and right in male and female.The inner thickness in the coronal plane of the posterior arch at the thinnest part of the vertebral artery groove（ITG） was（2.46±1.57） mm,（2.41±1.65） mm,（2.36±1.57） mm and（2.32±1.65） mm respectively on left and right in male and female.The outer thickness in the coronal plane of the posterior arch at the thinnest part of the vertebral artery groove（OTG） was（4.76±2.26） mm,（4.64±1.70） mm,（4.55±2.26） mm and（4.53±1.30） mm respectively on left and right in male and female.The middle height and width of the lateral mass（MHL and LW） was 13.68 mm and 12.98 mm respectively.The extraversion angle of lateral mass of atlas（α°） was 25°.Conclusion：Individual,sex,bilateral（left and right） diversity must be considered before operation.Blind operation must be prohibited in order to avoid injury of vertebral artery,nerve root and spinal cord.Atlas pedicle screw is longer than atlas lateral mass screw because of difference entry point between atlas pedicle screw and atlas lateral mass screw.