徒手寰枢椎椎弓根螺钉置入技术的安全性研究

发布时间：2018-04-27 08:01

本文选题：寰枢椎 + 椎弓根螺钉　；参考：《延安大学》2015年硕士论文

【摘要】：目的:通过对患者的寰枢椎术前CT影像进行解剖学结构测量,为临床采用徒手寰枢椎椎弓根螺钉置入法治疗上颈椎疾病提供参考数据,并探讨徒手寰枢椎椎弓根螺钉置入技术的安全性及有效性。方法:对我院2007-2014年骨科所收治寰枢椎骨折50例患者采用CT扫描,并应用MPR及Inspace软件对寰枢椎椎弓根进行测量,测量参数包括:寰枢椎椎弓根的上下径、椎弓根的内外径、椎弓根的上倾角、椎弓根的内倾角、椎弓根的长度、钉道最小内倾角、钉道最大内倾角及钉道最佳内倾角;通过椎动脉造影后测量寰椎横突孔处椎动脉与椎弓根的最大距离和理想内倾角,了解有无椎动脉行走异常及变异。手术方法采用徒手寰枢椎椎弓根螺钉置入技术:即对患者采用气管插管全麻,取后正中纵行切口,依次切开皮肤、皮下及筋膜,沿白线切开,棘突两侧骨膜下剥离颈后椎旁肌,寰椎向外至后结节旁开20mm、枢椎向外至关节突外缘为止,保护静脉丛、椎动脉及颈2神经根。螺钉的进钉位置根据CT选择在:寰椎为枢椎下关节突中点的矢状延长线和寰椎后弓上缘以下约3mm的水平面交点,枢椎为枢椎下关节突的中点,结合CT数据选择合适螺钉长度,置入直径为3.5mm的万向椎弓根螺钉。连接复位棒,复位,固定,冲洗,止血,放置引流管,逐层缝合伤口。结果:1.寰枢椎椎弓根CT测量的结果:寰椎椎弓根的上下径为(4.45±0.56)mm,寰椎椎弓根的内外径为(8.76±0.73)mm,寰椎椎弓根的上倾角为(7.77±0.62)o,寰椎椎弓根的内倾角为(9.13±0.46)o,寰椎椎弓根的长度为(27.88±1.23)mm;枢椎椎弓根的上下径为(5.09±0.43)mm,枢椎椎弓根的内外径为(6.62±0.46)mm,枢椎椎弓根的上倾角为(40.02±1.25)o,枢椎椎弓根的内倾角为(28.43±0.97)o,枢椎椎弓根的长度为(26.64±0.85)mm。2.寰椎椎弓根钉道在上倾角为最大、最小时,相应的内倾角度范围为(7.1-9.5)°、(7.0-9.4)°,钉道中心距寰椎横突处最大距离分别为4.6mm和4.3mm。3.在50例患者中,共观察到7例寰椎椎动脉沟环变异,其发生率为14.00%,其中后环变异6侧,占总变异率的85.14%,I、II、III、IV型后环变异发生率分别为2.00%、1.00%、1.00%、2.00,侧环变异率为1.00%。4.测量结果显示,寰椎在10°内倾角时钉道最长,左右两侧分别为(27.83±1.78)mm和(27.85±1.67)mm;与0°、5°和15°相比无显著性差异(P0.05)。5.寰椎左右两侧椎弓根不同内倾角度进钉时的进钉点至后正中线的距离分析表明,在0°-15°内,寰椎左右两侧椎弓根进钉的进钉点至后正中线的距离呈递增趋势,在同一角度下,左右两侧角度其中角度无显著性差异(P0.05),不同角度间相比具有显著性差异(P0.05)。6.一年的随访,结果显示患者恢复状况良好,螺钉无松动变形等状况产生,50例患者的中优良率达96.00%,置钉的准确率达97.50%。结论:通过对术前CT影像进行观察和测量,为寰枢椎椎弓根螺钉的准确置入提供必要的参考和指导,从而进一步提高了寰枢椎椎弓根螺钉技术的安全性和准确性。在手术治疗上颈椎损伤中可以获得满意的疗效,值得广泛推广。
[Abstract]:Objective: to provide the reference data for the treatment of the upper cervical spine by the unarmed atlantoaxial pedicle screw placement, and to explore the safety and effectiveness of the unarmed atlantoaxial pedicle screw placement technique by measuring the anatomic structure of the CT images of the atlantoaxial vertebral arch before the operation of the atlantoaxial vertebral pedicle screw. 50 cases of fracture were scanned with CT, and MPR and Inspace software were used to measure the pedicle of atlantoaxial pedicle. The parameters included the upper and lower diameter of the atlantoaxial pedicle, the internal and external diameter of the pedicle, the obliquity of the pedicle, the length of the pedicle, the minimum angle of the nail canal, the maximum obliquity of the nail canal and the best obliquity of the nail canal. By measuring the maximum distance and ideal obliquity of vertebral artery and pedicle at the transverse process of atlas after vertebral arteriography, the abnormality and variation of the ambulation of vertebral artery were found. Fascia, cut along the white line, dissection the posterior cervical paravertebral muscle under the periosteum subperiosteum under the spinous process, the atlas outward to the posterior tubercle to open 20mm, the axis outward to the outer edge of the articular process to protect the venous plexus, the vertebral artery and the 2 nerve root of the neck. The screw position is selected according to CT: the atlas is the sagittal extension line of the middle point of the axis of the axis of the axis and the upper edge of the posterior arch of the atlas. At the horizontal intersection of 3mm, the axis was the middle point of the lower articular process of the axis, combined with the CT data to select the proper length of the screw, and put into the universal pedicle screw with a diameter of 3.5mm. Connecting the reset rod, repositioning, fixing, flushing, hemostasis, placing the drainage tube and suturing the wound by layer by layer. Results: the results of the 1. atlantoaxial pedicle CT measurement: the upper and lower diameter of the atlas pedicle. For (4.45 + 0.56) mm, the internal and external diameter of the pedicle of atlas is (8.76 + 0.73) mm, the obliquity of the pedicle of atlas is (7.77 + 0.62) O, the obliquity of the pedicle of atlas is (9.13 + 0.46) O, the length of the pedicle of atlas is (27.88 + 1.23) mm; the upper and lower diameter of the pedicle of the axis is (5.09 + 0.43), and the internal and external diameter of the pedicle of the axis is (6.62 +) mm, and the pedicle of the axis The obliquity was (40.02 + 1.25) O, and the dips of the pedicle of the axis were (28.43 + 0.97) O, the length of the pedicle of the axis was (26.64 + 0.85) mm.2. of the pedicle of the vertebral arch at the upper dip, and the minimum angle of angle was (7.1-9.5), (7.0-9.4), and the maximum distance between the center of the canal and the transverse process of the atlas was 4.6mm and 4.3mm.3. at 50, respectively. In the patients, 7 cases of atlas vertebral artery trench ring variation were observed, the incidence of which was 14%, of which 6 sides of the posterior ring variation, accounting for 85.14% of the total variation rate, I, II, III, and IV type posterior ring variation were 2%, 1%, 1%, 2 respectively, and the lateral ring variation rate was 1.00%.4., the longest and the left and right sides of the atlas in 10 degrees were the longest and the left and right sides were respectively ( 27.83 + 1.78) mm and (27.85 + 1.67) mm, compared with 0 degrees, 5 degrees and 15 degrees no significant difference (P0.05) the distance between the nail point and the posterior midline of the pedicle of the pedicle in the left and right vertebral arch of the.5. atlas showed that the distance between the entry point of the pedicle of the pedicle of the atlas and the posterior midline of the pedicle of the vertebral arch in the left and right sides of the atlas was increasing, and at the same angle. There was no significant difference in angle between the left and right sides (P0.05), and there was a significant difference between different angles (P0.05).6. one year follow-up. The results showed that the recovery of the patients was good, the screw had no loose deformation and so on. The excellent rate of the 50 patients was 96%, the accuracy of the nail was reached to the 97.50%. conclusion: through the preoperative CT image Observations and measurements provide the necessary reference and guidance for the accurate placement of atlantoaxial pedicle screws, thus further improving the safety and accuracy of atlantoaxial pedicle screw technology. It is worthy of extensive promotion in the surgical treatment of upper cervical spine injury.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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