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1、寰枢椎椎弓根影像学定位临床应用探究作者:贾卫斗贾薇薇史威白桂有【摘要】利用影像学资料测量寰枢椎椎弓根的各种数据,为临床应用提供客观依据,提高寰枢椎椎弓根内固定手术置钉的1次成功率。方法:2001.10〜2007.9月,对200份寰枢椎CR、DRX线片、MRI及64排CT片,通过图像储存传输系统(简称Paes)分析,测量寰枢椎椎弓根安全进钉点及安全进钉角度。利用自制的寰枢椎定位导向器,依据所测的安全进钉点及安全进钉角度对48例患者应用192枚寰枢椎椎弓根行经椎弓根内固定手术。结果:通过对这200份影像学资料分析测量后认为寰椎椎弓根安全进钉点:左侧(19.93
2、+1.32)mm,右侧(19.16+1.30)mm;寰椎椎弓根向内侧安全进钉角度:左侧(23・72±2.09)°,右侧(23.35±1.91)°;寰椎向头侧安全进钉角度(9.00±1.20)°o枢椎椎弓根安全进钉点:左侧(13.14+0.82)mm,右侧(13.85±0.79)mm;枢椎椎弓根向内侧安全进钉角度:左(24.52±1.26)。,右侧(20.42±1.42)°;枢椎向头侧安全进钉角度(25.00±3.00)°o48例病人平均随访10.6个月,按J0A评分标准,优31例,良14例,可2例,差1例,优良率93.75%O结论:利用对CR、DRX线片、
3、MRI及64排CT片等影像学资料,测量寰枢椎椎弓根各种数据,设计简便、程序简化、个性化强,对寰枢椎椎弓根内固定手术的实际操作有良好的指【关键词】寰枢关节放射摄影术体层摄影术/X线摄机[ABSTRACT]Objective:Toinvestigatetheanatomicaldataforpedicalscrewfixationforatlasandaxisbyradiographicmeasurementandtoimprovethesuccessrateofputtingscrew・Methods:ThepointsofputtingScrew,obli
4、quityangleofatlantoaxialxrayfilmsandCTscansfromoct2001tosep2007weremeasuredbyPACssystem.Thepediclefixationbetweenatlasandaxisfor48caseswithatlantoaxialinstabilitywastreatedwithscrewplatesystem,andbonyfusionbyselfmadepositionequipmentofputtigscrewpointofatlasaxis.Results:Thesafepoi
5、ntsofputtingscrewbyatlaspediceshouldbe:left19.93+1.32mm,right19.16±1.3mm;obliquityangleofputtingscrewtoinsidebyatlaspedicle:left(23.72±2.09°),right(23・35±1.91)°,obliquityangleofputtingscrewtofrontsidebyatlaspedicle:(9.00±l・20°);screwpointbyaxispedicle:left13.14±0.82mm,right13.85+0
6、.79mm;obliquityangleofputtingscrewtoinsidebyaxispedicle:left(24.52±1.26)°,right(20.42±1.42)°;obliquityangleofputtingscrewtothefrontsidebyaxispedicle:(25.00±3.00)°.Theaveragefollowedupperiodfor48caseswas10.5months・AccordingtoJOAScorestandard,31casesofthemwereexcellent,14caseswasgoo
7、d,2caseswerecommon,1casewasbad,andtherateofexcellentandgoodresuItswas93.75%.Conclusion:Measurementwithxray,CTscansCR,DRXandMRIhasbetterinstructiontoscrewpalatesystembyatlantoaxispedicle,beacuseofsimplificationofdesignandmethod.[KEYWORDS】AtlantoAxialJoint,Radiography,CT,寰枢椎不稳定将使颈脊髓
8、处于高危状态,多数需要手术治疗。经椎弓根寰枢椎内固定手术的关键是螺