| 枢椎棘突螺钉与椎弓根螺钉的解剖学比较 |
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Received:November 19, 2010
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| 作者 | Author | 单位 | Unit | E-Mail |
| 刘观燚 |
LIU Guan-yi |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
lgysimon@yahoo.com.cn |
| 徐荣明 |
XU Rong-ming |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 孙韶华 |
SUN Shao-hua |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 林华杰 |
LIN Hua-jie |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 冯建翔 |
FENG Jian-xiang |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 胡勇 |
HU Yong |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 赵刘军 |
ZHAO Liu-jun |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 周雷杰 |
ZHOU Lei-jie |
宁波市第六医院骨科,浙江 宁波 315040 |
Department of Orthopaedics,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 期刊信息：《中国骨伤》2011年24卷，第8期，第659-661页 |
| DOI：10.3969/j.issn.1003-0034.2011.08.011 |
| 基金项目:浙江省医药卫生优秀青年科技人才专项基金计划(编号:2010QNA021) |
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目的: 比较枢椎棘突螺钉和椎弓根螺钉的技术难度和相关解剖学参数,探讨枢椎棘突螺钉固定的可行性和安全性.
方法: 自2010年2月至7月,选取10具颈椎标本,男5具,女5具,年龄45～76岁,平均60.5岁.将标本俯卧,颈部置于中立位.从C1-C3剔除颈部后侧所有的软组织,以清楚地暴露枢椎侧块和峡部.枢椎椎体左右侧任意选择进行棘突螺钉和椎弓根螺钉固定,各10枚螺钉,置入直径为4.0 mm的皮质骨螺钉.枢椎棘突螺钉以枢椎棘突螺钉的进钉点选择为棘突的基底部、棘突和椎板的交界处,进钉角度水平置钉,螺钉由对侧棘突基底部穿出,形成双层皮质固定；枢椎椎弓根螺钉进钉点为枢椎下关节突根部中点,钉道方向与矢状面夹角15°～20°,与横断面夹角约30°.螺钉置入后,使用多层螺旋CT扫描机对标本进行扫描重建.测量螺钉在骨内的实际深度,记录椎弓根螺钉和棘突螺钉置钉失败、穿破椎弓根、进入椎管或置入横突孔的螺钉数目.
结果: 枢椎棘突螺钉和椎弓根螺钉的置入均无明显的技术困难.棘突螺钉未见螺钉置入椎管和劈裂棘突,但椎弓根螺钉有1枚螺钉突出椎弓根外侧皮质,侵犯横突孔.枢椎棘突螺钉的平均钉道长度为(21.4±1.4) mm,稍短于枢椎椎弓根螺钉的(23.7±1.0) mm,但两者间差异无统计学意义(t=-4.387,P>0.05).
结论: 枢椎棘突基底部具有螺钉固定的可行性,枢椎棘突螺钉较椎弓根螺钉固定相对安全、简单. |
| [关键词]:枢椎 内固定器 解剖学 摄影测量法 |
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| Anatomic comparison between spinous process screws and pedicle screws techniques of the second cervical vertebar |
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Abstract:
Objective: To compare anatomic difference between spinous process screws and pedicle screws techniques of the second cervical vertebra.
Methods: Ten human cadaveric of cervical spine(5 male,5 female) were harvested and had no gross deformities such as scoliosis and/or kyphosis were found in the study. The average age of the subjects was 60.5 years. The specimens were placed in the prone position. Posterior cervical exposure was attained by dissecting all soft tissue off the posterior aspect of the second cervical vertebra. After clear exposure of the lateral mass,the spinous process screw and pedicle screw insertion techniques were performed in this study. Each technique involved ten specimens and 10 screws inserted into C2 bilaterally. The one side of C2 was randomly selected for the spinous process screw and the other side was designate for the pedicle screw. This point then was drilled with a 3 mm drill,and followed by placement of a 4.0 mm cortical screw. The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0° caudally in the sagittal plane and about 0° medially in the axial plane. The starting point of pedicle screw should be the midpoint of the base of inferior articular facet of the axis. The drilling angle was 15° to 20° in the superior direction and 30° in the medial direction. After screw placement,all the specimens were CT scaned. On the CT scan,the length of the spinous process screw and pedicle screw trajectory were measured. Results were recorded for each screw that violated impinged of the pedicle,spinal canal and transverse process foramen.
Results: All the C2 spinous process screws were successfully placed,without impingement the spinal cord,the vertebral artery and the breakage of the spinous process. There was one pedicle screw breaking the pedicle into the vertebral artery foramen. The trajectory length for the spinous process screws were(21.4±1.4) mm,compared with the pedicle screws(23.7±1.0) mm. But there was no significant differences between spinous process screws and pedicle screws techniques(t=-4.387,P>0.05).
Conclusion: The C2 spinous process screw fixation has the anatomic feasibility and is easier to perform than pedicle screw fixation. |
| KEYWORDS:Axis Internal fixators Anatomy Photogrematry |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘观燚,徐荣明,马维虎,孙韶华,林华杰,冯建翔,胡勇,赵刘军,周雷杰.枢椎棘突螺钉与椎弓根螺钉的解剖学比较[J].中国骨伤,2011,24(8):659~661 |
| 英文格式: | LIU Guan-yi,XU Rong-ming,MA Wei-hu,SUN Shao-hua,LIN Hua-jie,FENG Jian-xiang,HU Yong,ZHAO Liu-jun,ZHOU Lei-jie.Anatomic comparison between spinous process screws and pedicle screws techniques of the second cervical vertebar[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(8):659~661 |
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