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目的通过对正常人螺旋CT多平面重建检查,并对其行后路经关节螺钉内固定技术相关形态学参数的测量,为临床提供患者个体化手术相关信息。方法对60例正常人进行寰椎的螺旋CT检查,获取相关参数并进行分析。采用枢椎下关节突正中为进钉点模拟寰枢椎后路经关节螺钉内固定术,在螺旋CT重建上获得轴面和矢状面的正确倾斜角度。C2峡部高度和宽度,理想的螺钉长度,理想的螺钉矢状面和轴面倾斜度,以及理想的螺钉路径与椎动脉沟之间距离。结果C2峡部高度为(8.02±1.92)mm,峡部宽度(6.05±1.32)mm,理想的螺钉长度为(41.22±4.48)mm,螺钉矢状面倾斜度为53.87°±5.61°,与内向成角(14.81°±2.81°)。10侧(8%)峡部狭窄(宽度或高度小于5mm),测量其椎动脉沟与理想螺钉途径之间距离,有12例(10%)小于2.5mm,因此总共有22侧(18%)存在潜在椎动脉损伤风险。结论术前对每个患者行CT检查十分必要,能充分地了解个体的解剖结构,提高手术的安全性。
OBJECTIVE: To provide information about the individualized surgery for patients through the multiplanar reconstruction of normal spiral CT and the measurement of the related morphological parameters of posterior screw fixation. Methods Sixty normal subjects were examined by spiral CT on atlas and the related parameters were obtained and analyzed. The midpoint of the inferior axis of the inferior articular process was used as the entry point to simulate posterior atlantoaxial joint screw fixation. The correct inclination of the axial and sagittal planes was obtained on spiral CT reconstruction. C2 isthmus height and width, ideal screw length, ideal sagittal and axial inclination of the screw, and the distance between the ideal screw path and the vertebral artery groove. Results The height of C2 isthm was (8.02 ± 1.92) mm, the width of isthmus (6.05 ± 1.32) mm, the ideal length of screw was (41.22 ± 4.48) mm, the sagittal inclination of screw was 53.87 ° ± 5.61 °, (14.81 ° ± 2.81 °). Ten (8%) isthmuses were narrow (width or height less than 5mm) and the distance between the vertebral artery groove and the ideal screw path was measured. Twelve (10%) were less than 2.5mm and therefore a total of 22 (18%) were present Risk of potential vertebral artery injury. Conclusion Preoperative CT examination of each patient is necessary to fully understand the individual anatomy and improve the safety of surgery.