【作者】 郭晓东；

【导师】 张建湘； 杨庆国；

【作者基本信息】 安徽医科大学 ， 外科学， 2002， 硕士

【摘要】 目的：本研究主要是测量颈椎弓根和毗邻结构之间的量化关系；以及通过放射影像学研究，描述椎弓根在X线片上的影像特点，为在颈椎弓根内安全置钉提供帮助，以减少并发症。 方法：1)在15具经福尔马林防腐处理的尸体上，去除颈椎棘突，椎板，相关韧带及侧块，上、下关节突；暴露出颈椎弓根的狭窄部及毗邻的神经组织，测量：(1)椎弓根狭窄部的横径(PW)和高度(PH)；(2)椎弓根狭窄部内壁间的距离(IPD)以及该节段硬膜囊横径(DSW)；(3)椎弓根内壁与硬膜囊的距离(PDSD)；(4)椎弓根上缘与相邻上位神经根下缘的最近距离(PSRD Nt)，最远距离(PSRD Ft)；(5)椎弓根下缘与相邻下位神经根上缘的最近距离(PIRD Nt)，最远距离(PIRD Ft)；(6)测量冠状面上，神经根轴线与脊髓后碎中线的夹角(REA)；(7)椎弓根横截面椭圆形的长轴与脊柱后干中线的夹角(OPAA)。2)制备6套颈椎骨标本，以细钢丝缠绑在椎弓根狭窄部，克氏针中置于椎弓根的内部；摄颈椎正、侧、斜位片，观察椎弓根形态在不同投照位置中的变化。 结果：1)15具标本中，PDSD：0-6.2mm。PSRD Nt：0-2.9mm，PSRD Ft：2.72-9.60mm。PIRD Nt：0-4.1mm，PIRD Ft：0.96-5.731mm。PW：4.5-8.2mm，PH：3.6-6.7mm。IPD：21.0-25.4mm，DSW：13.5-18.3mm。REA：39°-102°，OPAA：-12°-44°。2)X线片：椎弓根的正位片影像是椎体两侧倾斜的管状结构，椎弓根椭圆形截面的长轴向内倾斜。侧位片上椎弓根没有被直接显示，只为重叠在椎体后上壁的高密度影。斜位片清楚的显示了椎弓根狭窄部的四个侧壁及其截面形状。椎弓根的放射学表现处于其真实骨皮质的影像之内。 结论：在大多数的情况下，颈椎弓根与毗邻的神经结构之间存在着一定的距离，相对而言，向椎弓根的内、上方置钉是安全的。颈椎斜位片与椎弓根的轴位片有安徽医科大学硕士学位论文较好的相关性。颈椎正、斜位片的椎弓根影像可以较好地反映椎弓根的形态，对了解椎弓根个性化的特点及置钉有重要意义。术中侧位影像辅助置钉的作用应重新评价。更多还原

【Abstract】 Objective: The primary purpose of the current study is to avoid and minimize the complication in performing the technique, by providing accurate quantitative anatomic data of the relation of the cervical spine to the adjacent neural structure and describing the pedicle image in the roentgenogram.Methods: 15 cadavers were used for dissection to observe the relations of the cervical spine to the adjacent neural structure. After removal of whole posterior bony element of the cervical spine, the isthmus of the pedicles, the nerve roots of C3-C7 and the dural sac were exposed. The parameters of the cervical pedicles and the distance between the pedicle and the adjacent structure were measured directly. In addition, 6 fresh-bone cervical spine specimens were prepared and the isthmus of the pedicle were drawn tightly with radiopaque fine malleable wire, the cervical spine were then imaged to determine the correlation between the pedicle cortex and the radiologic image. Results: In 15 cadavers, PDSD: 0-6.2mm0 PSRD Nt: 0-2.9mm, PSRD Ft: 2.72-9.60mnio PIRD Nt: 0-4.1mm, PIRD Ft: 0.96-5.73mm0 PH: 4.5-8.2mm, PW:3.6-6.7mm0 IPD: 21.0-25.4mm, DSW: 13.5-18.3mmo REA: 39?102? OPAA: -12-44. In the roentgenogram, 1): the image of the pedicle is an oblique tube structure lateral to the cervical vertebrate in the PA radiograph; the long axis of C5-7 pedicle ellipse is oblique to the vertical. 2): The pedicle image isn’t shown directly in lateral radiograph, the intensive density area made by the overlapping pedicles is superior on the posterior wall of the vertebrate. 3): Four lateral cortex border and the shape of the cervical pedicle are demonstrated clearly in the oblique radiograph, theradiologic pedicle image is consistent within the true bony cortex of the pedicle. Conclusion: There are some difference in the distances between the cervical pedicle and the adjacent neural structure more frequently. This study indicates the placement of the pedicle screw medially and superiorly in the middle and lower cervical pedicle is proper o About the roentgenogram, the radiologic pedicle image in the cervical spine is a reliable guide to the true bony cortex of the pedicle. The coaxial image of the pedicles is well correlated with the oblique radiograph of the cervical spine, it is a very useful to grasp the feature of every pedicle accepting the transpedicular screw as well as the PA radiograph. The lateral fluoroscopic assistance for transpedicular fixation in the cervical spine needs to be re-evaluated.更多还原