国人寰椎应用Resnick技术置入椎弓根螺钉后相关径线的解剖学及CT测量的比较研究

发布时间：2018-03-13 10:25

本文选题：寰椎　切入点：椎弓根螺钉　出处：《宁夏医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过对国人寰椎标本采用Resnick技术置入椎弓根螺钉后相关径线的解剖学及CT测量,分析比较两种测量结果,评价解剖学及影像学测量在螺钉植入中的一致性,从而为Resnick技术在国人寰椎置钉中的安全性及可靠性提供理论支撑和数据参考。实验方法宁夏医科大学解剖学教研室提供的20例国人头颈标本(排除破损、畸形的标本,且不分性别、年龄、身高及体重等)。标本解剖后选取寰枢椎复合体20例置于自制标本固定器上,定位解剖标志后采用Resnick技术置入椎弓根螺钉,即:选取枢椎峡部中央的垂线与寰椎后弓上下缘中点的交点作为进针点(A),使螺钉垂直于冠状面并与矢状面呈100倾斜角,即内倾角(α);在水平面上向头侧倾斜50,即上倾角(β)。植入螺钉建议选择3.5mm直径,穿出点记为B。寰椎的测量分三步:一、植钉前测量,使用电子数显卡尺测量寰椎后弓最薄处的高度(h)及宽度(w);进钉点至后结节垂线的距离(d);二、影像学测量,植钉后先测量螺钉上倾角(β)后标本给予三维CT平扫重建,用量角器测量内倾角(α),并测量寰椎后弓最薄处宽度(w)及高度(h),螺钉钉道长度(AB),内侧安全间隙(S1)、外侧安全间隙(S2),进钉点至后结节垂线的距离(d);三、剖面测量,沿椎弓根螺钉平面水平剖开寰椎为上下两半,测螺钉内倾角(α)、螺钉钉道长度(AB);脊髓安全距离(S1),即内侧安全间隙,血管安全距离(S2),即外侧安全间隙。最后将测量的解剖学和影像学相关数据,采用SPSS19.0软件进行统计学分析。结果解剖学测量结果:(1)寰椎后弓最薄处高度(h):左侧5.02±0.28mm,右侧5.42±0.54mm;宽度(w):左侧9.71±1.04mm,右侧8.51±1.13mm;(2)进钉点至寰椎后结节垂线的距离(d):左侧19.01±1.92mm,右侧18.9±2.06mm;(3)钉道长度(AB):左侧25.00±2.92mm,右侧24.21±2.70mm;(4)内侧安全间隙(S1):左侧2.11±0.31mm,右侧2.63±0.72mm;外侧安全间隙(S2):左侧3.24±0.88mm,右侧3.73±0.53mm;(5)螺钉内倾角(α):左侧为8.1±2.0°,右侧为9.6°±2.00;上倾角(β):左侧5.2°±1.1°,右侧为4.8°±1.3°。影像学测量结果:(1)寰椎后弓最薄处高度(h):左侧5.35±0.49mm,右侧5.73±0.68;宽度(w):左侧10.14±1.57mm,右侧9.73±1.33mm;(2)进钉点至寰椎后结节垂线的距离(d):左侧18.10±2.93mm,右侧18.82±2.12mm;(3)钉道长度(AB):左侧26.60±1.89mm,右侧25.11±2.52mm;(4)内侧安全间隙(S1):左侧2.42±0.55mm,右侧2.74±0.82mm;外侧安全间隙(S2):左侧3.64±0.78mm,右侧3.99±0.70mm;(5)螺钉内倾角(α):左侧为8.70±2.5°,右侧为10.2o±2.70;上倾角(β):左侧5.60±1.6°,右侧为5.10±1.4°。结论通过影像学及解剖学的测量,均证实国人寰椎植入椎弓根螺钉是安全的,可行的,并推荐进针点的解剖定位为:枢椎峡部中央的垂线与寰椎后弓上下缘中点的交点作为进针点,使螺钉垂直于冠状面并与矢状面呈100倾斜角,向头侧倾斜50。
[Abstract]:Objective to analyze and compare the anatomical and CT results of atlas specimens of Chinese atlas after pedicle screw placement with Resnick technique, and to evaluate the consistency of anatomical and imaging measurements in screw implantation. In order to provide theoretical support and data reference for the safety and reliability of Resnick technique in Chinese atlas nailing, 20 Chinese head and neck specimens (excluding damaged and deformed specimens) were provided by Anatomy Teaching and Research Department of Ningxia Medical University. After dissection, 20 cases of atlantoaxial complex were placed on a self-made specimen fixator, and the pedicle screw was inserted with Resnick technique. That is, the point of intersection between the perpendicular line in the central part of the axis isthmus and the middle point of the upper and lower margin of the posterior arch of atlas is chosen as the point of insertion, which makes the screw perpendicular to the coronal plane with a 100 inclination angle to the sagittal plane. That is, the angle of internal inclination (伪); tilt 50 to the side of the head on the horizontal plane, that is, the angle of inclination (尾). The diameter of the implant screw should be 3.5 mm, and the measurement of the puncture point recorded as B.atlas is divided into three steps: first, the measurement before the screw implantation, The height and width of the thinnest posterior arch of atlas were measured by electronic digital caliper. The distance from the point of entry to the vertical line of posterior tubercle was measured. The angle of inclination (伪) and the height of the posterior arch of atlas were measured by means of a protractor, the length of the screw nail passage was ABN, the inner safe gap was S1, the outer safe space was S2, the distance between the point of entry and the perpendicular line of the posterior tubercle was measured, and the distance between the point of entry and the perpendicular line of the posterior tubercle was measured. The atlas was cut horizontally along the pedicle screw plane. The angle of internal inclination of the screw was measured (伪), the length of the nail canal was ABN, and the safe distance of the spinal cord was S1, that is, the medial safe space. The safe distance of blood vessels is called the lateral safe space. Finally, the anatomical and radiography-related data are measured. Results SPSS19.0 software was used for statistical analysis. Results Anatomical measurements showed that the height of posterior arch of atlas was 5.02 卤0.28 mm on the left and 5.42 卤0.54 mm on the right; the width of the posterior arch was 9.71 卤1.04 mm on the left and 8.51 卤1.13 mm on the right) the distance from the point of nail to the vertical line of the posterior atlas was 19.01 卤1.92 mm on the left and 18.9 卤2.06mm on the right). ABN: left 25.00 卤2.92 mm, right 24.21 卤2.70 mm / 4) medial safety gap S _ (1): left 2.11 卤0.31 mm and right side 2.63 卤0.72 mm; lateral safe space S _ (2): left 3.24 卤0.88 mm, right side 3.73 卤0.53 mm) Intrascrew inclination angle (伪: left 8.1 卤2.0 掳and right side 9.6 掳卤2.00; upper inclination: left 5.2 掳卤1.1 掳, right 4.8 掳卤1.3 掳) atlas. Height of posterior pedicle: left 5.35 卤0.49 mm, right side 5.73 卤0.68; width: left 10.14 卤1.57 mm, right side 9.73 卤1.33 mm / 2) distance from nail point to perpendicular line of posterior tubercle of atlas: left 18.10 卤2.93 mm, right 18.82 卤2.12 mm / 3) length of nail canal: left 26.60 卤1.89 mm, right 25.11 卤2.52mm / 4) outer space of S1U: left 2.42 卤0.55mm, right 2.74 卤0.82mm; The internal inclination of the screw was 3.64 卤0.78 mm on the left side and 3.99 卤0.70 mm on the right side (伪: 8.70 卤2.5 掳on the left side and 10.2o 卤2.70 on the right side), and the upper inclination angle (尾: 5.60 卤1.6 掳on the left side and 5.10 卤1.4 掳on the right side). It is proved that pedicle screw implantation is safe and feasible in Chinese, and the anatomical orientation of the insertion point is recommended as follows: the point of intersection between the perpendicular line in the central part of the axis isthmus and the midpoint of the upper and lower margin of the posterior arch of the atlas as the point of entry. The screw is perpendicular to the coronal plane with a 100 inclination angle to the sagittal plane, and the head is tilted 50.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3;R322.7

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