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目的 :为寰枢椎区病损机制和手术治疗提供解剖学依据。方法 :在 15 0例中国成年人干燥寰枢椎标本上 ,对具有临床意义的数据进行解剖学测量。结果 :寰椎上关节面内倾角、下关节面外倾角及侧块内倾角两侧不对称分别占 19.3 %、10 .7%和 7.3 % ;椎动脉沟处形成沟环者占 16 .0 % ;所有横突孔的前后径和横径均大于 4mm ;后弓内侧半距仅为外侧半距的 1/2。枢椎椎弓根内倾角变异较大 (-3 .5°～2 1.5°) ;齿突腰部宽度小于 9mm者占 71.2 % ,齿突后倾角的变异较大 (0°～ 2 2°) ;2 7.5 %的椎动脉在经过枢椎侧块下方时会形成一动脉压迹沟 ,致使侧块外端和椎弓根变薄。结论 :①寰枢椎的解剖学形态与其生物力学性质及损伤机制密切相关 ;②手术时寰椎前弓向外显露不宜超过 2 0mm ,后弓切除向外不宜超过 10mm ,经寰枢外侧关节融合或内固定术应选择在关节的内侧 2 /3 ;③大部分中国人不适宜于两枚齿突螺钉内固定术 ;④ 2 7.5 %的中国人不适宜于经椎弓根螺钉固定术 ,枢椎椎弓根变异较大 ,手术前应作CT检测。
Objective: To provide anatomical basis for the mechanism of atlantoaxial degeneration and surgical treatment. METHODS: Anatomical measurements of clinically meaningful data were performed on atlantoaxial specimens from 150 Chinese adults. Results: The asymmetry of the atlas, the inferior facet joint and lateral camber on the atlas facet accounted for 19.3%, 10.7% and 7.3%, respectively. The mean diameter of the vertebral artery groove was 16.0% ; All transverse foramen were greater than 4mm anteroposterior diameter and transverse diameter; medial half of the posterior arch was only 1/2 of the lateral half-distance. The variation of pedicle inclination was larger (-3.5 ° -2.5 °). The width of the odontoid lumbar region was less than 9 mm, accounting for 71.2%. The variation of posterior odontoid angle was larger (0 ° -22 °). 7.5 7.5% of the vertebral arteries will form an arterial groove when they pass under the lateral mass of the lateral arch, resulting in thinning of the lateral mass and lateral pedicle. Conclusions: ①The anatomical shape of atlantoaxial axis is closely related to its biomechanical properties and injury mechanism. ② The anterior arch of atlas should not be more than 20 mm outward and the posterior arch should not be more than 10 mm. Or internal fixation should be selected in the medial joint 2/3; ③ most Chinese are not suitable for two sets of desmoid screw fixation; ② 2 7.5% of Chinese are not suitable for trans-pedicle screw fixation, pivot Vertebral pedicle variation larger, CT should be done before surgery.