| 寰椎椎弓根显露置钉技术的影像学测量研究 |
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Received:December 20, 2015
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| 期刊信息：《中国骨伤》2016年29卷，第10期，第903-909页 |
| DOI：10.3969/j.issn.1003-0034.2016.10.007 |
| 基金项目:首都临床特色应用研究（编号：Z141107002514058） |
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目的：利用CT三维重建对椎动脉沟后弓高度<4 mm的寰椎进行置钉通道相关参数测量，探讨椎弓根显露置钉技术的意义。
方法：回顾性分析2015年4月至2015年6月行颈椎CT三维重建检查且排除上颈椎畸形、手术的患者90例，其中单侧或双侧椎动脉沟后弓高度<4 mm的51例，共84侧。利用其图像数据行寰椎三维数字化重建，并分别测量置钉通道相关数据。
结果：51例患者中，椎动脉沟处后弓最低高度为（3.28±0.51） mm，侧块高度、宽度、与后弓移行处高度均可容纳3.5 mm直径螺钉置入。0°~15°（0°、5°、10°、15°）理想椎弓根螺钉钉道长度依次为（27.36±1.81）、（27.01±1.68）、（27.07±1.75）、（27.48±1.72） mm，椎弓根显露置钉技术钉道长度依次为（23.44±1.79）、（23.87±1.84）、（24.58±1.89）、（25.56±2.01） mm，侧块螺钉钉道长度为（20.78±2.05） mm。螺钉通道5个截面的CT值均值分别为椎弓根螺钉（701.89±141.48） HU、侧块螺钉（599.11±137.33） HU.0°~15°理想椎弓根螺钉通道长度之间差异无统计学意义（P>0.05），0°~15°椎弓根显露置钉法钉道长度随内倾角增加而增长（P<0.05），且均比侧块螺钉钉道长（P<0.05），椎弓根螺钉通道穿过骨质CT值均值高于侧块螺钉通道（P<0.01）。
结论：利用椎弓根显露置钉技术可完成椎动脉沟处后弓高度<4 mm的寰椎置钉，且钉道长度损失不多，穿行骨量较大，预期把持力良好。 |
| [关键词]:寰椎 椎弓根螺钉 侧块螺钉 放射摄影影像解释,计算机辅助 |
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| Pedicle exposure technique for atlas screw fixation:a radiological research |
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Abstract:
Objective:To investigate the meaning of pedicle exposure technique for screw fixation on atlas with the vertebral groove height less than 4 mm by using reconstructive computed tomography.
Methods:From April 2015 to June 2015,84 pedicles of 51 patients with groove heights less than 4 mm were studied by digital reconstruction respectively. Parameters of atlas pedicle screw fixation were measured.
Results:Among the 51 cases,the vertebral groove height was (3.28±0.51) mm. Lateral mass heights,lateral mass widths and the transition area heights between lateral mass and posterior arch were fit for 3.5 mm screw implanting. Ideal pedicle screw trajectory lengths from 0° to 15° (0°,5°,10°,15°) were (27.36±1.81),(27.01±1.68),(27.07±1.75),(27.48±1.72) mm,exposed trajectory lengths from 0° to 15°(0°,5°,10°,15°) were(23.44±1.79),(23.87±1.84),(24.58±1.89),(25.56±2.01) mm,trajectory length of lateral mass was (20.78±2.05) mm. The mean CT values on 5 sections through pedicle trajectory and lateral mass trajectory were (701.89±141.48) HU and (599.11±137.33) HU,respectively. There were no significant differences between ideal pedicle trajectory lengths from 0° to 15°(P>0.05). Exposed trajectory lengths was significantly increased accompanying with medial angles increasing (P<0.05),and was longer than trajectory lengths of lateral mass (P<0.05). CT value of pedicle screws was higher than CT value of lateral mass screws significantly (P<0.01).
Conclusion:Screws can be implanted in atlas with vertebral groove height less than 4 mm by using pedicle exposure technique. Few trajectory lengths will be sacrificed with favorable pull-out strength due to adequate bone mass purchased. |
| KEYWORDS:Atlas Pedicle screw Lateral mass screw Radiographic image interpretation,computer-assisted |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 麻昊宁,刘楚吟,姜良海,移平,杨峰,唐向盛,谭明生.寰椎椎弓根显露置钉技术的影像学测量研究[J].中国骨伤,2016,29(10):903~909 |
| 英文格式: | MA Hao-ning,LIU Chu-yin,JIANG Liang-hai,YI Ping,YANG Feng,TANG Xiang-sheng,TAN Ming-sheng.Pedicle exposure technique for atlas screw fixation:a radiological research[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(10):903~909 |
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