寰枢椎椎弓根螺钉技术的应用解剖研究

目的：对寰枢椎进行应用解剖学测量，为临床提供寰枢椎椎弓根螺钉技术的解剖学参数。方法：采用游标卡尺和量角器测量60例120侧寰椎和枢椎防腐湿骨标本。结果：寰椎侧块宽度为（12．72±1．56）mm，侧块长度为（23．60±1．66）mm，侧块高度为（12．46±1．62）mm，椎弓根中点至侧块前缘的距离为（29．34±2．02）mm；中线至寰椎椎管外缘的距离为（13．81±1．06） mm，中线至寰椎椎弓根中点的距离为（18．02±1．74）mm，中线至寰椎横突孔内壁的距离为（22．06±1．96）mm；椎管外缘至横突孔内壁的距离为（8．25±1．62）mm；寰椎椎弓根中点至枢椎神经根上缘的垂直距离为（5．23±0．56）mm；寰椎后弓最薄处的宽度为（9．66±1．44）mm，高度为（4．60±1．11）mm，其中38侧的寰椎后弓最薄处高度〈4mm，占31．3％，17侧〈3．5mm，占14．2％；寰椎侧块角为（24．6±1．1）°。枢椎椎弓根宽度为（7．60±1．20）mm，椎弓根高度为（7．82±1．22）mm，椎弓根＋侧块的长度为（28．33±2．14）mm，内斜角为（14．2±2．0）°，上倾角为（40．1±2．1）°。结论：解剖学测量可提供寰枢椎椎弓根螺钉技术的可行性、进针点、进针方向和进针深度。

ANATOMICAL STUDY ON TRANSPEDICLE SCREW FIXATION OF ATLAS AND AXIS

Objective： To provide the anatomic parameter for transpedicular screw fixation of atlas and axis. Methods：Sixty moist atlas（CL ） and axis（C2 ） vertebral specimens were measured. Results： The height/ length/width of lateral mass of atlas was （12.72± 1.56）mm/（23.60± 1.66）mm/（12.46± 1.62）mm respectively, and the distance from the midpoint of pedicle to the anterior edge of lateral mass was （29.34±2.02）mm. The distance from the median line to the outer edge of vertebral canal/to the midpoint of pedicle/ to the inner wall of transverse foramen of atlas was （13.81±1.06）mm/（18.02±1.74）mm/（22.06±1.96） mm respectively. The distance from the outer edge of vertebral canal to the inner wall of transverse foramen of atlas was （8.25±1.62）mm. The vertical dimension from the midpoint of pedicle of atlas to the upper edge of C2 nerve root was （5.23±0.56）mm. The width and height of posterior arch in the thinnest part was （9.66±1.44）mm and （4.60±1. 11）mm,respectively, but there were 38 sides（31.3%） which height of posterior arch in thinnest part were less than 4 mm and 17 （14.2%）sides less than 3.5 mm among these 38 sides. The longitudinal direction angle of C1 lateral mass to the sagittal plane was （24.6±1.1）°. The height and width of pedicle of axis was （7. 60±1.20）mm and （7.80±1.22）mm,respectively, the length of pedicle plus lateral mass was （28.33±2.14）mm, the longitudinal direction angle of C2 lateral mass to the sagittal plane （the median inclination angle of screw） was （14.2±2.0）° and the longitudinal direction angle of C2 pedicle to the horizontal plane （the superior inclination angle of screw） was （40.1±2.1）°. Conclusion： The anatomical parameter could be provided the feasibility, needling point, needling direction and needling depth for transpedicular screw fixation of atlas and axis.