摘要
目的通过解剖学研究为临床选择颈椎后路钢板螺钉固定的最佳操作方法提供依据。方法取15具尸体的C3～7 作为解剖标本 ,男11具 ,女4具 ;年龄35～70岁。以C3～7 上、下小关节突最外缘的连线为外边线 ,以关节突与椎板相交处的连线为内边线 ,在下关节突最下缘做水平线为关节突的上、下边线 ,在内外、上下边线中点处分别做连线 (横中线、纵中线 )将关节突分为四个区域 ,两连线交点处为关节突的中心点 ,分别测量关节突的长度和宽度。切除左侧小关节后 ,观测颈神经根及椎动脉在其表面的投影位置。于右侧关节突距中心点内侧1mm处先后以垂直和倾斜两种方式行克氏针模仿螺钉固定。结果颈神经根走行于内上、内下及外下三个区域内 ,椎动脉位于中间垂直线稍内侧。当克氏针进钉角度向外侧偏斜15°～35°、向头侧偏斜5°～25°时 ,克氏针尖端可在外上安全区穿透关节突前方骨皮质 ,避免损伤椎动脉和颈神经根 ,所获进钉深度均大于同一椎体的垂直法所获进钉深度 (P<0.01)。结论克氏针倾斜进钉方法操作安全、简单 ,可有效地避免意外损伤的发生 。
Objective An anatomical experimental study in order to provide anatomical data for screw position and direction in posterior cervical plate-screw fixation. Methods Fifteen cervical specimens(C 3-7) of human cadavers (11 males, 4 females) aged from 35 to 70 years were used in this study. The line joining the facet posterolateral borders was defined as the lateral line of the lateral mass. A line drawn from one junction to the next junction of the facet and lamina was defined as the medial line of lateral mass. A transverse line through the inferior border of inferior facet joint was defined as the superior line or inferior line of lateral mass. Two connecting lines, the transverse and the longitudinal middle lines respectively passing through the lower most inferior borders of the articular facet, and the mid-point on the lateral and medial lines divided the lateral mass into quadrants. The intersection of the two connecting lines was the center of lateral mass. The length and width of lateral mass were measured. The positions of nerve roots and vertebral arteries were observed after facetectomies. Kirschner wires were drilled 1 mm medial to the center of lateral mass either vertically or 15°superior and 25°lateral to the vertical direction. The depths and angulations of drilled-in wires were measured. The syntopy of the wires with nerve roots and vertebral arteries were measured at the intervertebral foramen. Results Nerve roots are observed in the superior medial, inferior medial and inferior lateral quadrants. Vertebral arteries coursed along the medial side of the rostrocaudal line. The wire drilled 5°-25°superior and 15°-35°lateral to the vertical direction can safely increase the depth of insertion and avoid injuring the vertebral artery and nerve root. Conclusion The screws position and direction can be adjusted to avoid injuring the vertebral artery and nerve root in posterior cervical plate-screw fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第5期279-282,共4页
Chinese Journal of Orthopaedics
关键词
颈椎
内固定器
骨螺丝
解剖学
Cervical vertebrae
Internal fixators
Bone screws
Anatomy
