寰椎椎弓根螺钉理想进钉通道的选择

发布时间：2018-04-27 02:38

本文选题：寰椎 + 椎弓根螺钉　；参考：《南京医科大学》2015年硕士论文

【摘要】：目的:三维重建寰椎松质骨及大体形态,并以此为依据设计寰椎椎弓根螺钉的理想进钉通道,减少进钉时的阻力及穿透并发症。方法:选择60例(男、女各30例)志愿者行寰椎薄层CT扫描(扫描条件:电压220V,层厚0.75mm,间隔0.8mm),所得影像资料利用Mimics10.01软件三维重建出寰椎内部松质骨及其大体形态。根据三维重建图像及原始影像资料确定寰椎椎弓根中心点C,以C点为螺钉理想钉道的中心点,寰椎椎弓根头倾角为螺钉理想钉道的头倾角(国人寰椎椎弓根高度较小,螺钉头尾向倾角变化较小,因此选择理想钉道的头尾倾角与寰椎椎弓根轴向头倾角一致)。测量螺钉在侧块松质骨内的可置角度变化范围,并以最大内、外倾角的角平分线作为理想钉道的进钉角度。定义理想钉道与后弓的交点为进钉点,然后测量该进钉点与各解剖标志之间的相关参数。结果:男女理想螺钉进钉点至椎弓根内侧壁的距离L1分别为(7.89±1.39),(7.30±0.98)mm;至正中矢状面的距离L2分别为(22.86±2.30),(21.23±1.64)mm;至椎弓根上下缘距离之比L3/L4分别为(1.00±0.10),(1.01±0.11)。男女理想螺钉的内倾角度α分别为(11.70±5.68)°,(11.70±5.48)°;其中最大内倾角度α1分别为(32.51±5.79)°,(30.52±6.40)°;最大外倾角度α2分别为(9.10±7.80)°,(7.04±7.13)°。男女椎弓根宽度D分别为(9.70±1.57),(8.70±1.24)mm;高度H分别为(5.24±1.15),(4.38±0.81)mm。60名志愿者影像资料均模拟置入直径为3.5mm的螺钉,共计120枚,其中有10枚(男1例1侧,女5例9侧)因椎弓根高度较小或解剖变异而穿破椎弓根,比例为8.33%。结论:理想螺钉的进钉点在椎弓根内侧壁旁开7-8mm处后弓上下缘的中央,螺钉内倾(11-12)°左右,并与椎弓根共轴。
[Abstract]:Objective: to reconstruct the cancellous bone and gross morphology of atlas, and to design the ideal screw entry channel for atlas pedicle screw, so as to reduce the resistance and penetrating complication. Methods: 60 volunteers (30 male and 30 female) underwent thin slice CT scan of atlas (voltage 220 V, slice thickness 0. 75 mm, interval 0. 8 mm). The images were reconstructed by Mimics10.01 software. According to the 3D reconstruction image and the original image data, the center point C of the pedicle of atlas was determined, and the angle of the head inclination of the pedicle of atlas was the angle of the ideal screw nail canal (the height of the pedicle of atlas was small in China). The angle of head and tail inclination of screw is small, so the angle of head and tail inclination of ideal nail canal is the same as that of axial head angle of atlas pedicle. The angle of the screw in the lateral mass of cancellous bone was measured, and the angle of the maximum internal and external inclination angle was taken as the angle of the ideal nail path. The point of intersection between the ideal nail path and the posterior arch is defined as the point of entry, and the relevant parameters between the point and the anatomic markers are measured. Results: the distance between male and female ideal screw entry point to the medial wall of pedicle was 7.89 卤1.39mm. the distance to the median sagittal plane was 2.86 卤2.30mm. the distance between male and female ideal screw was 21.23 卤1.64mm. the distance to the upper and lower edge of pedicle was 1.00 卤0.10mm. the distance from L2 to the median sagittal plane was 1.01 卤0.11mm. The inclinations of ideal screws for men and women were 11.70 卤5.68 掳and 11.70 卤5.48 掳respectively, in which the maximum angle 伪 _ 1 was 32.51 卤5.79 掳and the maximum external angle 伪 _ 2 was 9.10 卤7.80 掳and 7.04 卤7.13 掳, respectively. The pedicle width D of male and female were 9.70 卤1.57 and 8.70 卤1.24mm, respectively, and the height H was 5.24 卤1.15m and 4.38 卤0.81)mm.60 respectively. The imaging data of all the male and female volunteers simulated the placement of screws with diameter of 3.5mm, of which 10 were (male 1 case, 1 side). In 5 cases (9 sides), the pedicle was broken because of low pedicle height or anatomic variation, the ratio was 8.33. Conclusion: the point of entry of the ideal screw is at the center of the upper and lower margin of the posterior arch at the side of the medial lateral wall of the pedicle of the pedicle, and the screw tilts inwards about 11-12 掳, and coaxial with the pedicle of the pedicle.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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