寰枢椎椎弓根影像学测量及临床应用

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1、寰枢椎椎弓根影像学测量及临床应用作者：贾卫斗，郑铁钢，杨博贵，白桂有，许英杰，云德才【摘要】［目的］探讨利用影像学资料，测量寰枢椎椎弓根的数据，提高寰枢椎椎弓根置钉的成功率。［方法］对寰枢椎CR、DRX线片、MRI及64排CT片，通过图像储存传输系统，测量寰椎椎弓根进行进钉点、进钉角度的测量。［结果］寰椎椎弓根进钉点：左侧(19.93±1.32)mm，右侧(19.16±1.30)mm；寰椎椎弓根向内侧进钉角度：左侧23.72°±2.09°，右侧23.35°±1.91°；寰椎向头侧进钉角度9°±1.2°。枢椎椎弓根进钉点：左侧(13.14±0.82)mm，右侧(13

2、.85±0.79)mm；枢椎椎弓根向内侧进钉角度：左侧24.52°±1.26°，右侧20.42°±1.42°；枢椎向头侧进钉角度25°±3°。对48例患者行寰枢椎椎弓根经椎弓根内固定手术。其中男35例，女13例。年龄22～61岁，平均43.60岁。Ⅱ型陈旧性齿状突骨折22例，齿状突不连12例，横韧带损伤14例。所有患者X线片示寰椎完全复位，枢椎齿状突骨折处对位良好。平均10.6个月，均获得骨性融合。按JOA评分标准，优31例，良14例，可2例，差1例，优良率93.75％。［结论］利用影像学资料测量，对寰枢椎椎弓根内固定手术的实际操作有良好的指导意义。【关键词】寰枢

3、椎；椎弓根；影像学资料；测量；内固定9Abstract：［Objective］Toprovidequantitativedataofatlantoaxialpedicleforitssurgicalscrewinternalfixationbyimageologymeasurementandimprovethesuccessrateofthesurgicaltreatment.［Method］TheexaminationsofCR,DRX,MRIand64-rowCTwereperformedineachpatientpreoperatively,andtheat

4、lantoaxialpedicalscrewentrypointsandscrewentryangleswerethenmeasuredbyPACseesystem.［Result］Theatlaspediclescrewentrypointswerelocalizedpositionwhichitsdistancetotheleftoftheatlaspediclemidlinewas(19.93±1.32)mm,andtotherightoftheatlaspediclemidlinewas(19.16±1.30)mm.Thescrewentryanglest

5、otheinsideoftheatlaspediclewerelocalizedpositionwhichitsdistancetotheleftoftheatlaspediclemidlinewas(23.72±2.09)°,andtotherightoftheatlaspediclemidlinewas(23.35±1.91)°.Thescrewentryangletotheheadoftheatlaspediclewas(9.00±1.20)°.Theaxispediclescrewentrypointswerelocalizedpositionwhichi

6、tsdistancetotheleftoftheaxispediclemidlinewas(13.14+0.82)mm,andtotherightoftheaxispediclemidlinewas(13.85±0.79)mm.Thescrewentryanglestoinsideoftheaxispediclewerelocalizedpositionwhichitsdistancetotheleftoftheaxispediclemidlinewas(24.52±1.26)°,andtotherightoftheaxispediclemidlinewas(20

7、.42±1.42)°,The9screwentryangletotheheadoftheaxispediclewas(25±3)°.48patientsweretakentreatmentwithatlantoaxialpediclesurgicalscrewintemalfixation.Amongthesepatients,therewere35malesand13femaleswithameanage43.60yearsold(ranged22to61yearsold),22patientswithtypeIIoldodontoidfracture,12pa

8、tient