| 下颈椎棘突椎板螺钉固定的解剖学研究 |
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Received:November 22, 2011
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| 期刊信息：《中国骨伤》2012年25卷，第7期，第594-598页 |
| DOI：10.3969/j.issn.1003-0034.2012.07.016 |
| 基金项目:浙江省宁波市科学技术局自然科学基金项目(编号：2010A610061) |
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目的：测量成人下颈椎棘突椎板的解剖学参数,探讨下颈椎棘突椎板固定的可行性。
方法：取20具C3-C7尸体标本,仔细解剖以清楚地暴露椎板和棘突。分别采用手工和CT测量椎板高度、厚度;以棘突和椎板的交界处进钉,对侧椎板中上端背侧出钉,通过CT重建测量螺钉进钉角度、钉道长度及钉尖与椎动脉、脊髓的距离;随机抽取100例正常成年人下颈椎CT图像测量下颈椎棘突根部中缘宽度、棘突椎板交界处椎板中缘厚度,分析置钉可行性。
结果：所有螺钉均成功置入,未发现螺钉侵犯椎管、横突孔。下颈椎标本各节段椎板高度、厚度的手工测量值与CT测量值比较无统计学差异(P>0.05);重建CT测量C3-C7节段椎板高度、厚度逐渐增大,分别为(12.4±1.2)～(13.7±1.3) mm和(4.5±0.9)～(5.4±1.1) mm,差异有统计学意义(P<0.05);螺钉钉道长度呈增大趋势(13.7±1.2)～(15.8±1.8) mm,差异有统计学意义(P<0.05);螺钉钉尖与椎动脉、脊髓的距离分别为(20.1±2.7)～(25.8±2.9) mm和(4.1±1.8)～(5.0±1.2) mm;横断面的前倾角度为(73.0±9.9)°～(85.3±10.1)°,差异无统计学意义(P>0.05);100例正常成年人下颈椎CT图像测量棘突根部宽度及椎板中缘厚度最小值均为C4,分别为(8.5±1.1) mm和(4.3±0.5) mm,最大值均为C7,分别为(14.5±2.0)mm和(6.0±1.1) mm .
结论：下颈椎棘突椎板螺钉固定技术具有解剖学可行性,棘突椎板螺钉内固定存在一个安全、稳定的进钉区间。 |
| [关键词]:颈椎 内固定器 解剖学 |
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| Anatomic study of lower cervical spinous process for laminar screw fixation |
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Abstract:
Objective: To measure anatomic data of spinous process and vertebral plate and evaluate the possibility of fixation of spinous process and vertebral plate.
Methods:Twenty cadaveric cervibal spines of C3-C7 were dissected to expose vertebral plate and spinous process,and were measured by two methods,one was manual measured using digital caliper and the other was computed tomography scaning. Parameters were measured manually including vertebral plate height and width. The screw was inserted from the boundary of the vertebral plate and spinous process,and gone out from the top of vertebral plate back of opposite side. Then through the CT reconstruction,angle of screw insertion,length of screw trajectory and distance between the screw tip and vertebral artery and spinal cord were measured. Additionally,spinous process width and vertebral plate thickness of 100 patients'CT scans of C3-C7 cervical segment were measured to evaluate possibility of screw insertion at spinous process and vertebral plate.
Results: The screw fixation of lower cervical spinous process and vertebral plate were successfully placed,without impingement of spinal cord and vertebral artery. There was no statistic difference on the data of lamina height and width of 20 cadaver specimens between manual and CT measurements(P>0.05). Height and width of vertebral plate was (12.4±1.2) to (13.7±1.3) mm and (4.5±0.9) to (5.4±1.1) mm respectively and increased gradually from C3 to C7 (P<0.05). The trajectory length was (13.7±1.2) to (15.8±1.8) mm and increased gradually from C3 to C7 (P<0.05). The distance between screw tip and vertebral artery and spinal cord was (20.1±2.7) to (25.8±2.9) mm and (4.1±1.8) to (5.0±1.2) mm respectively. The angles of screws insertion were (73.0±9.9)° to (85.3±10.1)° in the axial plane (P>0.05). Based on the CT measurements of 100 patients,the data of the spinous process width and lamina thickness varied from a minimum of (8.5±1.1) mm and (4.3±0.5) mm for the C4,to a maximum of (14.5±2.0) mm and (6.0±1.1) mm for the C7 respectively.
Conclusion:Lower cervical spinous process and vertebral plate screw fixation is feasible,which is a safe and stable screw approach for spinous process and vertebral plate fixation. |
| KEYWORDS:Cervical vertebrae Internal fixators Anatomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 林华杰,徐荣明,刘观燚,马维虎,孙韶华,黄燎原.下颈椎棘突椎板螺钉固定的解剖学研究[J].中国骨伤,2012,25(7):594~598 |
| 英文格式: | LIN Hua-jie,XU Rong-ming,LIU Guan-yi,MA Wei-hu,SUN Shao-hua,HUANG Liao-yuan.Anatomic study of lower cervical spinous process for laminar screw fixation[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(7):594~598 |
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