本文關(guān)鍵詞： 下頸椎 椎弓根 形態(tài)測(cè)量 螺釘內(nèi)固定 螺旋CT　出處：《內(nèi)蒙古醫(yī)學(xué)院》2008年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】： 目的探討成人下頸椎椎弓根螺釘內(nèi)固定的相關(guān)解剖學(xué)參數(shù),為臨床應(yīng)用選擇螺釘直徑、長(zhǎng)度、角度,入釘點(diǎn)定位及判斷手術(shù)復(fù)位等提供理論依據(jù)。方法利用電子游標(biāo)卡尺(精確度0.01mm)及量角器(精確到1°)對(duì)31套成人C3～C7干燥骨標(biāo)本椎弓根最窄處的寬和高、椎弓根相關(guān)角度、椎弓根軸線(xiàn)長(zhǎng)的測(cè)定,椎弓根入釘點(diǎn)(左右、上下)間距的測(cè)量,通過(guò)螺旋CT沿椎弓根最窄處垂直斷面掃描,測(cè)量椎弓根最窄處各緣皮質(zhì)骨厚度,松質(zhì)骨寬和高,并分別計(jì)算各階段側(cè)別及性別的均數(shù)和標(biāo)準(zhǔn)差,用獨(dú)立樣本t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)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(shì),同節(jié)段側(cè)別間和性別間比較均無(wú)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(jì)均呈兩端大、中間小(C5)的趨勢(shì),除C7 A′B′性別間有顯著性差異外(P＜0.05),其余均無(wú)顯著性差異,A′B′/PH值接近50%;(3)椎弓根最窄處各緣皮質(zhì)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(zhì)骨厚度接近相等。(4)C′D′及A′B′均值說(shuō)明,同節(jié)段均為C′D′小于相應(yīng)的A′B′。(5)椎弓根軸線(xiàn)骨性長(zhǎng)度、椎弓根長(zhǎng)(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L(zhǎng)a長(zhǎng)度的1/2。(6)椎弓根A角、B角:A角兩性合計(jì)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(wú)顯著性差異;B角C3～C7由負(fù)變正,并呈逐漸增大趨勢(shì)。(7)同一椎骨左、右入釘點(diǎn)間距(σO):C3～C7合計(jì)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(diǎn)間距(O′O′):四個(gè)節(jié)段合計(jì)均值在14.37～14.92mm之間,總均值為14.59mm。結(jié)論下頸椎椎弓根螺釘直徑主要取決于松質(zhì)骨的寬度,但應(yīng)注意個(gè)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(zhǎng)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(diǎn)間距是術(shù)中螺釘入釘點(diǎn)定位、判斷手術(shù)復(fù)位程度的重要依據(jù)。
[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(xué)位授予單位】：內(nèi)蒙古醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類(lèi)號(hào)】：R687.3;R322

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本文編號(hào)：1554830