寰枢椎椎弓根影像学定位的临床应用研究

The Radiographic Base Study and Clinical Application of Atlantoaxial Pedicle

目的：利用影像学资料测量寰枢椎椎弓根的各种数据．为临床应用提供客观依据，提高寰枢椎椎弓根内固定手术置钉的1次成功率。方法：2001．10～2007．9月．对200份寰枢椎CR、DRX线片、MRI及64排CT片，通过图像储存传输系统（简称Pacs）分析，测量寰枢椎椎弓根安全进钉点及安全进钉角度。利用自制的寰枢椎定位导向器，依据所测的安全进钉点及安全进钉角度对48例患者应用192枚寰枢椎椎弓根行经椎弓根内固定手术。结果：通过对这200份影像学资料分析测量后认为寰椎椎弓根安全进钉点：左侧（19．93±1．32）mm．右侧（19．16±1．30）mm；寰椎椎弓根向内侧安全进钉角度：左侧（23．72±2．09）°，右侧（23．35±1．91）°；寰椎向头侧安全进钉角度（9．00±1．20）°。枢椎椎弓根安全进钉点：左侧（13．14±0．82）mm，右侧（13．85±0．79）mm；枢椎椎弓根向内侧安全进钉角度：左（24．52±1．26）°，右侧（20．42±1．42）°；枢椎向头侧安全进钉角度（25．00±3．00）°。48例病人平均随访10．6个月，按JOA评分标准，优31例，良14例，可2例．差1例，优良率93．75％。结论：利用对CR、DRX线片、MRI及64排CT片等影像学资料，测量寰枢椎椎弓根各种数据，设计简便、程序简化、个性化强，对寰枢椎椎弓根内固定手术的实际操作有良好的指导意义。

Objectlve：To investigate the anatomical data for pedical screw fixation for atlas and axis by radiographic measurement and to improve the success rate of putting screw. Methods： The points of putting Screw,obliquity angle of atlantoaxial x-ray films and CT scans from oct 2001 to sep 2007 were measured by PACs system. The pedicle fixation between atlas and axis for 48 cases with atlantoaxial instability was treated with screw-plate system,and bony fusion by self-made position equipment of puttig screw point of atlas axis. Results：The safe points of putting screw by atlas pedice should be：left 19. 93±1.32mm, right 19.16±1.3mm; obliquity angle of putting screw to inside by atlas pedicle： left（23. 72±2.09°） , right （23. 35±1.91 ）°, obliquity angle of putting screw to front side by atlas pedicle： （9.00±1.20°） ;screw point by axis pedicle： left 13.14±0. 82mm,right 13.85±0.79mm;obliquity angle of putting screw to inside by axis pedicle：left（24.52± 1.26）°, right（20. 42±1.42）°;obliquity angle of putting screw to the frontside by axis pedicle.. （25.00±3.00）°. The average followed-up period for 48 cases was 10. 5 months. According to JOA Score standard, 31 cases of them were excellent, 14 cases was good, 2 cases were common, 1 case was bad, and the rate of excellent and good results was 93.75 %. Conclusion：Measurement with x-ray ,CT scans CR,DRX and MRI has better instruction to screw-palate system by atlanto-axis pedicle,beacuse of simplification of design and method.