颈椎前路钢板并轴向螺钉固定治疗屈曲牵张型损伤的解剖学研究

目的　提出一种联合颈椎前路钢板固定治疗屈曲牵张型颈椎损伤的新术式-颈椎轴向螺钉固定术，进行解剖学可行性研究。 方法 随机调取50例正常成年志愿者的颈椎侧位片。年龄22～48岁，平均28岁。通过JW-PACS图像系统，测量C2～6椎体高度；C2/3～C5/6椎间盘高度以及椎间盘矢径；并模拟轴向螺钉固定，即下位椎体前下缘至上位椎体后上缘的连线，测量轴向螺钉最大长度、头倾角以及植骨块深度等。采用一例防腐成人尸体标本，在C臂X线机透视下，模拟颈椎前路钢板固定并颈椎轴向螺钉固定术。 结果 轴向螺钉最大长度为(41.18±3.92)mm，轴向螺钉头倾角为（25.21±3.58）°。植骨块合适深度应小于椎间盘矢径（17.09±1.50）mm，且大于（11.69±1.63）mm，即略大于12 mm。尸体模拟手术表明，颈椎前路轴向螺钉固定在C2/3、C3/4、C4/5、C5/6均可以顺利完成， C6/7节段由于胸骨阻挡，无法进行轴向螺钉固定。 结论 颈椎前路钢板并轴向螺钉固定术治疗屈曲牵张性损伤具有操作可行性。

Anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction injury: anatomic study

Objective　To study the anatomical flexibility of anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction.　Methods　Fifty cases of digital lateral X-ray films from adult healthy volunteers aged 24~48 years, with mean 28 years, were measured directly in the JW-PACS picture system. Measuring parameters included vertebral body height, intervertebral disc height and disc depth. The line started from anteroinferior point of the inferior vertebrae to posterosuperior point of the superior vertebrae was drawn to mimic the axial screw fixation in the lateral film. The maximal screw length, screw cephalic inclination angle and the distance between screw and anterior vertebral margin at disc level was recorded. Simulated anterior cervical plating and axial screw fixation was carried out in one preserved human specimen under the guidance of C-arm X-ray fluoroscope.　Results　The maximal length of anterior cervical axial screw was (41.18±3.92 )mm, and the axial screw inclination angle (25.21±3.58)°. The suitable depth of interbody graft was more than （11.69±1.63）mm, but less than （17.09±1.50）mm of disc depth. Simulated procedure in the preserved specimen demonstrated that axial screw fixation could be successfully completed at C2/3, C3/4, C4/5, and C5/6 levels, but difficult be performed at C6/7 due to obstacle of sternum.　Conclusions　The flexibility of axial screw fixation plus anterior cervical plating is confirmed from this study for managing of cervical flexion-distraction injuries.