Atlas钛缆固定上颈椎的解剖与临床

目的: 观察寰椎后弓和枢椎椎板的形态学特征, 以更为安全、方便地开展颈后路寰枢椎Atlas钛缆固定术。方法: 观察 100套寰椎后弓和枢椎椎板的形态学特点并进行解剖学测量, 设计引导钛缆穿绕的特殊的器械, 并应用于 17例上颈椎损伤患者的手术操作。结果:(1) 寰椎后弓较纤弱, 横截面呈扇形, 内侧面从后上方向内下方倾斜; 枢椎椎板较粗大, 上窄下宽, 内侧面基本垂直, 内侧面下缘多形成一骨嵴; (2) 寰椎后弓的引导器要求头端折弯, 枢椎椎板引导器要求头端圆钝; (3) 17例患者手术操作均安全、顺利完成, 无脊髓损伤等并发症发生。结论: 根据寰椎后弓和枢椎椎板的形态学特征, 穿绕钛缆时宜自上向下操作; 采用专用的引导器使得颈后路寰枢椎Atlas钛缆固定术的操作更为安全、方便。

Anatomical and clinical study for the operation of upper cervical fixation with Atlas titanium cable

Objective:To observe morphological character of posterior arch of atlas and lamina of axis and provide anatomical bases for the operation of upper cervical posterior fixation with Atlas titanium cable and related for this operation.Method:The posterior arch of atlas and lamina of axis were observed and measured in 100 adult dry cadaveric atlas and axis specimens, special devices were designed based on the anatomical data and were used in 17 cases' operations.Result:(1) The posterior arch of atlas was thin with a fan-shape section, whose inner plane descend from back to inside and the lamina of axis was stronger and thicker than posterior arch of atlas, with a vertical inner plane and a ridge near the lower edge. (2) The guide of the special device for posterior arch of atlas should be designed with a curved head and that for lamina of axis should be designed with a head. (3) All operations were performed safely without any spinal complications.Conclusion: (1) During the operation of upper cervical posterior fixation with Atlas titanium cable,the cable should be slided from superior to lower inner wall of posterior arch of atlas or lamina of axis; (2)The operation of upper cervical posterior fixation with Atlas titanium cable will be more safely with the help of special devices which were designed based on the anatomical character.