下颈椎椎弓根螺钉内固定相关结构的应用解剖学研究

发布时间：2018-03-02 03:26

本文关键词： 下颈椎椎弓根形态测量螺钉内固定螺旋CT　出处：《内蒙古医学院》2008年硕士论文　论文类型：学位论文

【摘要】： 目的探讨成人下颈椎椎弓根螺钉内固定的相关解剖学参数,为临床应用选择螺钉直径、长度、角度,入钉点定位及判断手术复位等提供理论依据。方法利用电子游标卡尺(精确度0.01mm)及量角器(精确到1°)对31套成人C3～C7干燥骨标本椎弓根最窄处的宽和高、椎弓根相关角度、椎弓根轴线长的测定,椎弓根入钉点(左右、上下)间距的测量,通过螺旋CT沿椎弓根最窄处垂直断面扫描,测量椎弓根最窄处各缘皮质骨厚度,松质骨宽和高,并分别计算各阶段侧别及性别的均数和标准差,用独立样本t检验进行统计学分析。结果(1)椎弓根最窄处宽(PW、C′D′):C3～C7 PW、C′D′两性均为逐渐增大趋势,同节段侧别间和性别间比较均无显著性差异(P＞0.05);C′D′/PW值均接近60.0%;(2)椎弓根最窄处高度(PH、A′B′):C3～C7两性合计均呈两端大、中间小(C5)的趋势,除C7 A′B′性别间有显著性差异外(P＜0.05),其余均无显著性差异,A′B′/PH值接近50%;(3)椎弓根最窄处各缘皮质骨厚度(AB、CD、EF、GH):C3～C7外缘极薄,仅在1.01～1.22mm之间,AB/CD总均值为1.53倍,而GH/EF值变化范围为90.3%～100%,即上、下缘皮质骨厚度接近相等。(4)C′D′及A′B′均值说明,同节段均为C′D′小于相应的A′B′。(5)椎弓根轴线骨性长度、椎弓根长(La、Lb):La和Lb其变化范围较小,La、Lb总平均值分别为31.17mm、16.31mm,Lb/La总均值为52.4%,其Lb约为La长度的1/2。(6)椎弓根A角、B角:A角两性合计均值C7最大,C3～C7总平均值为46.37°,性别差异除C5有显著性差异外(P＜0.05),其余均无显著性差异;B角C3～C7由负变正,并呈逐渐增大趋势。(7)同一椎骨左、右入钉点间距(σO):C3～C7合计均值十分接近,C5最大,总平均值为41.04mm;(8)相邻椎骨上下入钉点间距(O′O′):四个节段合计均值在14.37～14.92mm之间,总均值为14.59mm。结论下颈椎椎弓根螺钉直径主要取决于松质骨的宽度,但应注意个体差异,C3～C6仅可用3.0mm的螺钉,而C7可用3.5mm的螺钉;螺钉长度选用范围30～31mm,置入角度有明显规律性,左右、上下入钉点间距是术中螺钉入钉点定位、判断手术复位程度的重要依据。
[Abstract]:Objective to study the anatomical parameters of adult lower cervical pedicle screw fixation, and to select the screw diameter, length and angle for clinical application. Methods the width and height of pedicle of 31 adult C3C7 dry bone specimens were measured by electronic Vernier caliper (accuracy 0.01 mm) and protractor (accurate to 1 掳). The length of pedicle axis, the distance between pedicle insertion point (left and right, upper and lower) were measured. The thickness of cortical bone, the width and height of cancellous bone were measured by spiral CT scanning along the vertical section of pedicle at the narrowest part of pedicle. The mean and standard deviation of side sex and sex in each stage were calculated respectively, and the statistical analysis was carried out by independent sample t test. Results 1) there was a gradual increasing trend of both sexes in the narrowest part of pedicle. There was no significant difference between the same segment and sex. (P > 0.05 P > 0. 05% PW value were close to 60. 010%) the height of the narrowest part of the pedicle and the height of PHA: C 3 + C 7 showed the trend of both ends being large and the middle of C 5 being small), and the difference between the two sexes was not significant (P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05%). Except that there was significant difference between sex (P < 0.05), there was no significant difference (P < 0.05). There was no significant difference (P < 0.05). The thickness of cortical bone at the narrowest point of pedicle and the thickness of the cortical bone at the narrowest part of the pedicle were extremely thin, and the total mean value of ABCD was 1.53 times between 1.011.22mm and 90.30.100mm, and the range of GH/EF value was 90.30.100mm. The proximal cortical bone thickness of the lower margin is close to equal. The mean values of Con D 'and AJ B' indicate that the same segment is less than the corresponding bone length of the pedicle axis. The total mean values of Lb / La and Lb are 31.17mm / 16.31mm / L ~ (-1) and 52.4mm / L ~ (1 / 2 / 6) respectively) the total mean of C _ (7) C _ (3) C _ (7) and C _ (3) C _ (7) are 46.37 掳, except for C _ (5). There was no significant difference in sex difference (P < 0.05), but there was no significant difference in C _ 3C _ 7 of angle B from negative to positive. The total mean value of the same vertebrae is close to the maximum of C5 (the total mean value is 41.04mm, the total mean value is 41.04mm): the total mean value of the four segments is 14.3714.92mm. Conclusion the diameter of pedicle screw of lower cervical vertebrae depends on the width of cancellous bone, but we should pay attention to the individual difference that C3C6 can only use 3.0mm screw, C7 can use 3.5mm screw, the length of screw is 300.31mm, and the angle of insertion is regular. On the left and right, the distance between the upper and lower points is an important basis for the location of screw insertion points and the degree of surgical reduction.
【学位授予单位】：内蒙古医学院
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R687.3;R322

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