本文關鍵詞： 下頸椎 椎弓根 形態(tài)測量 螺釘內固定 螺旋CT　出處：《內蒙古醫(yī)學院》2008年碩士論文　論文類型：學位論文

【摘要】： 目的探討成人下頸椎椎弓根螺釘內固定的相關解剖學參數(shù),為臨床應用選擇螺釘直徑、長度、角度,入釘點定位及判斷手術復位等提供理論依據。方法利用電子游標卡尺(精確度0.01mm)及量角器(精確到1°)對31套成人C3～C7干燥骨標本椎弓根最窄處的寬和高、椎弓根相關角度、椎弓根軸線長的測定,椎弓根入釘點(左右、上下)間距的測量,通過螺旋CT沿椎弓根最窄處垂直斷面掃描,測量椎弓根最窄處各緣皮質骨厚度,松質骨寬和高,并分別計算各階段側別及性別的均數(shù)和標準差,用獨立樣本t檢驗進行統(tǒng)計學分析。結果(1)椎弓根最窄處寬(PW、C′D′):C3～C7 PW、C′D′兩性均為逐漸增大趨勢,同節(jié)段側別間和性別間比較均無顯著性差異(P＞0.05);C′D′/PW值均接近60.0%;(2)椎弓根最窄處高度(PH、A′B′):C3～C7兩性合計均呈兩端大、中間小(C5)的趨勢,除C7 A′B′性別間有顯著性差異外(P＜0.05),其余均無顯著性差異,A′B′/PH值接近50%;(3)椎弓根最窄處各緣皮質骨厚度(AB、CD、EF、GH):C3～C7外緣極薄,僅在1.01～1.22mm之間,AB/CD總均值為1.53倍,而GH/EF值變化范圍為90.3%～100%,即上、下緣皮質骨厚度接近相等。(4)C′D′及A′B′均值說明,同節(jié)段均為C′D′小于相應的A′B′。(5)椎弓根軸線骨性長度、椎弓根長(La、Lb):La和Lb其變化范圍較小,La、Lb總平均值分別為31.17mm、16.31mm,Lb/La總均值為52.4%,其Lb約為La長度的1/2。(6)椎弓根A角、B角:A角兩性合計均值C7最大,C3～C7總平均值為46.37°,性別差異除C5有顯著性差異外(P＜0.05),其余均無顯著性差異;B角C3～C7由負變正,并呈逐漸增大趨勢。(7)同一椎骨左、右入釘點間距(σO):C3～C7合計均值十分接近,C5最大,總平均值為41.04mm;(8)相鄰椎骨上下入釘點間距(O′O′):四個節(jié)段合計均值在14.37～14.92mm之間,總均值為14.59mm。結論下頸椎椎弓根螺釘直徑主要取決于松質骨的寬度,但應注意個體差異,C3～C6僅可用3.0mm的螺釘,而C7可用3.5mm的螺釘;螺釘長度選用范圍30～31mm,置入角度有明顯規(guī)律性,左右、上下入釘點間距是術中螺釘入釘點定位、判斷手術復位程度的重要依據。
[Abstract]:Objective to study the anatomical parameters of adult lower cervical pedicle screw fixation, and to select the screw diameter, length and angle for clinical application. Methods the width and height of pedicle of 31 adult C3C7 dry bone specimens were measured by electronic Vernier caliper (accuracy 0.01 mm) and protractor (accurate to 1 擄). The length of pedicle axis, the distance between pedicle insertion point (left and right, upper and lower) were measured. The thickness of cortical bone, the width and height of cancellous bone were measured by spiral CT scanning along the vertical section of pedicle at the narrowest part of pedicle. The mean and standard deviation of side sex and sex in each stage were calculated respectively, and the statistical analysis was carried out by independent sample t test. Results 1) there was a gradual increasing trend of both sexes in the narrowest part of pedicle. There was no significant difference between the same segment and sex. (P > 0.05 P > 0. 05% PW value were close to 60. 010%) the height of the narrowest part of the pedicle and the height of PHA: C 3 + C 7 showed the trend of both ends being large and the middle of C 5 being small), and the difference between the two sexes was not significant (P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05% P > 0. 05%). Except that there was significant difference between sex (P < 0.05), there was no significant difference (P < 0.05). There was no significant difference (P < 0.05). The thickness of cortical bone at the narrowest point of pedicle and the thickness of the cortical bone at the narrowest part of the pedicle were extremely thin, and the total mean value of ABCD was 1.53 times between 1.011.22mm and 90.30.100mm, and the range of GH/EF value was 90.30.100mm. The proximal cortical bone thickness of the lower margin is close to equal. The mean values of Con D 'and AJ B' indicate that the same segment is less than the corresponding bone length of the pedicle axis. The total mean values of Lb / La and Lb are 31.17mm / 16.31mm / L ~ (-1) and 52.4mm / L ~ (1 / 2 / 6) respectively) the total mean of C _ (7) C _ (3) C _ (7) and C _ (3) C _ (7) are 46.37 擄, except for C _ (5). There was no significant difference in sex difference (P < 0.05), but there was no significant difference in C _ 3C _ 7 of angle B from negative to positive. The total mean value of the same vertebrae is close to the maximum of C5 (the total mean value is 41.04mm, the total mean value is 41.04mm): the total mean value of the four segments is 14.3714.92mm. Conclusion the diameter of pedicle screw of lower cervical vertebrae depends on the width of cancellous bone, but we should pay attention to the individual difference that C3C6 can only use 3.0mm screw, C7 can use 3.5mm screw, the length of screw is 300.31mm, and the angle of insertion is regular. On the left and right, the distance between the upper and lower points is an important basis for the location of screw insertion points and the degree of surgical reduction.
【學位授予單位】：內蒙古醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R687.3;R322

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本文編號：1554830