寰枢椎后路经关节螺钉内固定钉道与椎动脉的解剖学关系研究_临床医学论文.docVIP

寰枢椎后路经关节螺钉内固定钉道与椎动脉的解剖学关系研究_临床医学论文 寰枢椎后路经关节螺钉内固定钉道与椎动脉的解剖学关系研究_临床医学论文 作者：蔡贤华，江斌，陈庄洪，黄继峰，徐峰， 黄卫兵，刘曦明，王华松 【摘要】 ［目的］探讨寰枢椎后路经关节螺钉内固定术钉道的安全性。［方法］（1）在30套国人干燥寰枢椎标本上测量相关的解剖参数；（2）在6具国人尸体标本上行寰枢椎后路经关节螺钉内固定术，术后行X线及CT检查，观察椎动脉与钉道的解剖学关系。［结果］干燥标本上枢椎上关节面下椎动脉沟深（5.86±1.45）mm；15侧椎动脉沟延伸到枢椎上关节面下内侧1/3，达中1/3和外1/3者分别为36、9侧，其理想钉道内倾角分别为（26.4±3.44）°、（16.1±2.44）°和（15.1±2.24）°。CT图像上测得钉道与椎动脉最小距离位于枢椎椎动脉沟顶点2.75～5.78 mm。［结论］枢椎椎动脉沟的位置决定钉道的角度，在枢椎上关节面下钉道与椎动脉关系最为密切，但两者之间仍有一定的安全范围。 【关键词】 寰枢关节； 后路； 经关节螺钉内固定； 椎动脉； 解剖学 Abstract: ［Objective］To study the screw trajectory in the posterior atalanto-axial transarticular screw fixation. ［Methods］（1）The anatomical parameters related to the screw fixation were measured on 30 paired dry atlantoaxial specimens；（2）The X ray and CT scan were taken after C1、2 was fixed by posterior transarticular screws on 6 cadavers .These iterms were used to explore the anatomical relation of the vertebral artery and the screw trajectory in the posterior C1、2 fixation.［Results］The depth of the vertebral artery groove on the inferior surface of the superior facet of the axial was(5.86 1.45)mm; the vertebral artery groove extented the superior facet up to its medial third in 15 sides , up to the middle third and its lateral third respective in 35 and 9 sides,and the ideal screw trajectory medial angle of these specimens were(26.4±3.44)°,(16.1±2.44)°,(15.1±2.24)° respectively。The shortest distance between the vertebral artery and the screw trajectory lied in the topmost point of the vertebral artery groove of the axial on CT images ,and the interval was（ 2.75～5.78）mm.［Conclusion］The position of vertebral artery groove of the axial is the key to decide the angle of the screw trajectory.The shortest interval between screw trajectory and vertebral artery, safe for posterior atalanto-axial transarticular screw fixation, locates on the inferior surface of the superior facet of the axial. Key words：atlanto-axial joint； posterior approach; transarticular screw fixation; vertebral artery; ata