【作者】 王建华；

【导师】 刘景臣；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：对寰椎椎弓根进行解剖测量，更加深入了解其解剖，为临床椎弓根螺钉选择提供数据支持，同时对寰椎选定准确的进钉点，找到恒定的进钉参考系，并测量螺钉钉道与所选参考系的角度关系,从而确定正确的进钉方向，为寰椎椎弓根螺钉准确置入提供理论指导。方法：吉林大学白求恩医学部基础医学院解剖教研室提供的20具全套颈椎干燥骨标本（剔除畸形、骨折及病理性破坏的标本）。标本忽略年龄、性别、身高、体重等差别的影响。取其中寰椎共20个椎体标本。分别对20个标本两侧徒手行椎弓根钉螺置入。取寰椎侧块下方内外缘的中点在后弓上的投影距椎动脉沟底部后弓最薄处的垂直距离2mm处为置入螺钉的进钉点A，过寰椎侧块腹侧上方内外缘中点和进钉点A的失状面，通过此失状面的寰椎侧块上下缘中点为出钉点B。选择合适直径及长度的螺钉，直视下沿预先设定好的进钉方向置入。取出螺钉并将克氏针插入钉道代替螺钉中轴线，使用量角器测量：螺钉中轴线与正中矢状面形成的的横向角（X）；螺钉中轴线与寰椎所在平面所形成的纵向角（Y）。使用游标卡尺和直尺分别测量：寰椎椎动脉沟底部后弓最薄处的高度(h)；寰椎椎动脉沟底部后弓最薄处的宽度(w)；寰椎进钉点与后结节之间的垂直距离(S1);钉道全长(AB);寰椎侧块背侧下方内外缘之间的距离S2。使用SPSS软件统计分析数据。结果：（1）寰椎椎动脉沟底部后弓最薄处的宽度大于高度(w＞h），经t检验有差异性（P＜0.05）。（2）寰椎进钉点与后结节之间的垂直距离为21.2±3.5mm。（3）寰椎钉道全长(AB)为26.1±4.4mm。（4）寰椎侧块背侧下方内外缘之间的距离S2为11.1±1.1mm。（5）寰椎置钉的横向角（X）为10.9°±5.2°；纵向角（Y）为4.1°±0.7°。结论：取寰椎侧块下方内外缘的中点在后弓上的投影距椎动脉沟底部后弓最薄处的垂直距离2mm处为置入螺钉的进钉点；置钉取横向角6°～16°、纵向角3°～5°；选择直径为3.5mm，长度为21.7～30.5mm的螺钉安全、客观、可靠。更多还原

【Abstract】 Objective: Atlas pedicle anatomy to measure, more in-depthunderstanding of their anatomy, and provide clinically relevant data to helpchoose the right pedicle screw.Meanwhile, Atlas accurate entry points selected,find the constant reference system into the nail and nail into the direction ofmeasurement and the angle between the selected reference system to determinethe most appropriate direction into the screw, as a Atlas pedicle screw set intothe guidelines.Methods: Jilin University Department of Anatomy, House, provided a fullset of20specimens of cervical dried bone (excluding deformities, fracturesand pathological destruction of specimens.)Specimens, regardless of gender,age, height, weight and so on.Whichever is Atlas20vertebrae specimens.Onboth sides of20specimens were hand pedicle into snails. The point which isprojection of internal and external margin midpoint below lateral mass of atlason the posterior arch is entrance point of screw. The sagittal is decided byinternal and external margin of ventral of above lateral mass of atlas andentrance point of screw A，Sagittal traverse atals lateral up and down margin，its midpoint is the penetration point B.Select the appropriate diameter andlength of the screw, along the direction of the axis into the pedicle so that thepedicle screw axis and the axis of overlap (along the horizontal or sagittalpedicle sawn specimens can be seen at the screw in the pedicle axis.)Removethe screws and Kirschner wires instead of screws inserted in the axis of thescrew channel, use the protractor measurement: the screw axis in the horizontalplane and median plane forming the horizontal angle (X angle); screw axis inthe sagittal plane and the plane of Atlas formed by the side of the vertical angle (Y horn).Using vernier caliper and straightedge measurements: the height ofposterior arch at the thinnest part of the vertebral artery groove (h); the widthof posterior arch at the thinnest part of the vertebral artery groove (w); thedistance from entrance point of screw to median plane(S1);the whole lengthscrew path (AB)；the distance between the internal and external margin ofdorsal of below lateral mass of atlas（S2）。Statistical analysis of data usingSPSS software.Results:(1) the width is greater than the height of posterior arch at thethinnest part of the vertebral artery groove (w>h), the t test has difference (P<0.05);(2)the distance from entrance point of screw to median plane(S1=21.2±3.5mm);(3)the whole length screw path (AB=26.1±4.4mm)；(4)thedistance between the internal and external margin of dorsal of below lateralmass of atlas（S2=11.1±1.1mm）(5) atlas horizontal angle (X) are10.9°±5.2°;vertical angle (Y) were4.1°±0.7°.Conclusion: The sagittal is decided by internal and external margin ofventral of above lateral mass of atlas and entrance point of screw, transversehorizontal line intersecting the midpoint, the intersection of the entrance point.Pedicle screw placement in atlas takes horizontal angle from6°to16°, verticalangle from3°to5°.Select a diameter of3.5mm, a length from21.7mm to30.5mm screw safety, objective and reliable.更多还原