| 下颈椎前路椎弓根螺钉最佳进钉点和进钉方向的影像学研究及其临床运用 |
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Received:May 14, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 赵刘军 |
ZHAO Liu-jun |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
zhaoliujun555@sina.com.cn |
| 徐荣明 |
XU Rong-ming |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
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| 华群 |
HUA Qun |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
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| 蒋伟宇 |
JIANG Wei-yu |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
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| 朱彦召 |
ZHU Yan-zhao |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Department of Spinal Surgery, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China |
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| 期刊信息：《中国骨伤》2012年25卷，第12期，第1030-1035页 |
| DOI：10.3969/j.issn.1003-0034.2012.12.015 |
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目的：通过影像学研究下颈椎前路椎弓根螺钉置入的最佳进钉点及进钉方向,为临床运用提供依据。
方法：选取2008年1月至2010年12月行颈椎CT扫描、无明显下颈椎畸形的完整影像学资料50例,其中男27例,女23例;年龄38～83岁,平均58.5岁。在椎弓根水平轴位像上,分别测量C3-C7前路下颈椎椎弓根轴线的外倾角(α)、椎体前缘经椎弓根中轴线到侧块后缘的距离(AL);将椎体前缘等分为4个区,从所测量的椎弓根对侧开始记为1～4区,记录椎弓根轴线与椎体前缘交点所在的区域。在椎弓根矢状轴位像上,分别测量C3-C7椎弓根轴线的头倾或尾倾角(β)、椎体前缘经椎弓根中轴线到侧块后缘的距离(SL:sagittal length);将椎体前缘等分为4个区,从椎体上缘开始分别记为1～4区,记录椎弓根轴线与椎体前缘交点所在的区域。将上述资料行统计学分析,找出下颈椎前路椎弓根螺钉的最佳进钉点及进钉方向。并据此模拟置入下颈椎前路椎弓根螺钉。
结果：下颈椎水平轴位像上前路椎弓根外倾角在38°～45°,C3-C5逐渐增大,C5-C7逐渐减小;下颈椎矢状轴位像上,C3、C4前路椎弓根为头倾,C5基本水平,C6、C7为尾倾。C3-C5头倾角逐渐减小,C5-C7尾倾角逐渐增大。AL及SL从C3到C7呈现逐渐增加趋势。下颈椎椎弓根水平轴位像上,C3、C4及C5多数交点在2区内,C6在2区与3区内的数目基本相同,而C7则多数位于3区内。下颈椎椎弓根矢状轴位像上,C3、C4及C5多数交点在1区内,C6在1区与2区内的数目基本相同,而C7则多数位于2区。下颈椎椎弓根水平轴位像上交点在1区和4区的个数极少;而矢状轴位像上交点在3区及4区的个数极少。根据研究结果在临床上行3例共6枚下颈椎椎弓根螺钉的置入,均取得成功,未见并发症。
结论：下颈椎椎弓根螺钉最佳进钉点C3、C4、C5多数位于中线略偏向拟置钉椎弓根的对侧、椎体的上1/4区域内;而在C7则多数位于中线略偏向拟置钉椎弓根的同侧、椎体的上2/4区域内,C6位于两者间。下颈椎椎弓根螺钉的最佳进钉方向在水平轴位上为外倾38°～45°,C3-C5逐渐增大,C5-C7逐渐减小;而在矢状轴位像上,C3、C4为头倾5°～10°,C5水平,C6、C7为尾倾5°～10°。下颈椎前路椎弓根螺钉是一项可行的前路内固定技术。 |
| [关键词]:颈椎 体层摄影术,螺旋计算机 骨折固定术,内 |
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| Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine |
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Abstract:
Objective:To explore the best entry point and trajectory of anterior cervical screw in the cervical screw by radiological studies,and provide reference for clincal application.
Methods:From January 2008 to December 2010,50 patients were scanned by cervical CT and confirmed no obvious defect of lower cervical spine. Of them,27 cases were males and 23 were females,ranged the age from 38 to 83 years(mean 58.5 years). On horizontal axis,the camber angle of C3-C7 anterior lower cervical pedicle of vertebral arch axis(α) and distance between (axial length,AL) of anterior cervical pedicle axial line was measured from C3 to C7. Vertebral were divided into four areas,and from measured side of pedicle of vertebral began to record,orderly 1 to 4,the area of pedicle vertebral arch intersert into vertebral were recorded. On sagittal view,the head or tail angle(β) and length (sagittal length,SL) of anterior cervical pedicle axial line was also measured from C3 to C7. Vertebral were divided into four areas,and from measured side of pedicle of vertebral began to record,orderly 1 to 4,the area of pedicle vertebralarch arch intersert into vertebral were recorded. The above data were statistically analyzed to find the best entry point and trajectory of anterior cervical screw in the cervical screw and insert pedicle screw.
Results:The lateral angle of lower cervical spine was 38° to 45° on transverse plane,C3 to C5 increasing gradually,C5 to C7 decreasing. On sagittal view,C3,C4 pedicle were head tulting,C5 were basic level,C6,C7 were tail. C3 to C5 decreasing gradually,C5 to C7 increasing gradually. C3 to C7 in AL and SL increased gradually. On horizontal axis,the intersection of C3,C4 and C5 were in the second area,the number of C6 in the second and third area were the same,but C7 were in the third area. The intersection in the first and forth area were less. On sagittal view,the intersection of C3,C4 and C5 were in the first area,the number of C6 in third and forth area were less. Six pedicle screws of 3 cases were insert into lower cervical spine,and obtained good effects,no complications occurred.
Conclusion:The best entry point of C3,C4 and C5 were located in the center line and slightly to opposite vertebral body side and upper 1/4 area;C7 were located the vertebral body side and upper 2/4 area;C6 were located between them. The best insertion point were extraversion 38°to 45°,C3 to C5 increased graduallly,C5 to C7 decreased on horizontal axis;On sagittal view,C3,C4 for head 5°to 10°,C5 were basic level,C6,C7 for tail 5°to 10°。 The anterior cervical pedicle screw for lower cervial spine is a good and feasible internal fixation. |
| KEYWORDS:Cervical vertebrae Tomography,spiral conputed Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵刘军,徐荣明,华群,马维虎,蒋伟宇,朱彦召.下颈椎前路椎弓根螺钉最佳进钉点和进钉方向的影像学研究及其临床运用[J].中国骨伤,2012,25(12):1030~1035 |
| 英文格式: | ZHAO Liu-jun,XU Rong-ming,HUA Qun,MA Wei-hu,JIANG Wei-yu,ZHU Yan-zhao.Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(12):1030~1035 |
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