前路寰枢椎侧块螺钉内固定的解剖学与影像学研究

A study on anatomic and radiological measurement associated with anterior transarticular atlantoaxial fixation

目的通过成人寰枢椎复合体标本的直接测量和影像学间接测量,为前路寰枢椎侧块螺钉内固定的技术提供解剖学依据。方法选择10具寰枢椎标本及其CT图像,比较标本直接测量与CT图像间接测量的数据;依据测量结果确定进钉点及方向,置入寰枢椎侧块螺钉20枚。结果寰枢椎标本测得外偏角(17.74±2.03)度到(32.39±2.42)度,后倾角小于(26.42±1.63)度;CT图像测得外偏角在(17.51±0.92)度到(32.61±0.99)度,后倾角小于(26.46±1.40)度。CT图像测量值与标本测量值差异无统计学意义。在标本上模拟手术置钉,位置均理想。结论采用前路寰枢椎侧块螺钉内固定治疗上颈椎不稳是可行、安全、稳定的。

Objective To measure the atlato-axial joint complex directly on cadaver and inindirectly by imaging for providing an anatomic foundation for anterior approach transarticular screw fixation. Methods The position and direction of screw placement were decided according to the measurements. The accuracy was evaluated with CT film after 20 screws were inserted in lateral mass of the atlas and axis. Results With direct measuring, the maximum angles of transverse plane of screw implantation of anterior lateral mass of the atlas and axis were （17.74±2.03）degrees to （32.39±2.42） degrees and the maximum posterior slope angle was less than （26.42± 1.63） degrees, which were similar to （17.51±0.92 ） degrees to （32.61±0.99） degrees for theminimum angles of transverse plane and less than （26.46±1.40） degrees for the maximum posterior slope angle by CT imaging （P〉0.05）. The positions of screw placement on cadaver were all satisfied. Conclusion The anterior approach transarticular screw fixation for the treatment of instabile upper cervical spine is feasible, safe and stable.