本文選題：寰樞椎 + 椎弓根螺釘�。� 參考：《延安大學》2015年碩士論文

【摘要】：目的:通過對患者的寰樞椎術前CT影像進行解剖學結構測量,為臨床采用徒手寰樞椎椎弓根螺釘置入法治療上頸椎疾病提供參考數(shù)據(jù),并探討徒手寰樞椎椎弓根螺釘置入技術的安全性及有效性。方法:對我院2007-2014年骨科所收治寰樞椎骨折50例患者采用CT掃描,并應用MPR及Inspace軟件對寰樞椎椎弓根進行測量,測量參數(shù)包括:寰樞椎椎弓根的上下徑、椎弓根的內(nèi)外徑、椎弓根的上傾角、椎弓根的內(nèi)傾角、椎弓根的長度、釘?shù)雷钚?nèi)傾角、釘?shù)雷畲髢?nèi)傾角及釘?shù)雷罴褍?nèi)傾角;通過椎動脈造影后測量寰椎橫突孔處椎動脈與椎弓根的最大距離和理想內(nèi)傾角,了解有無椎動脈行走異常及變異。手術方法采用徒手寰樞椎椎弓根螺釘置入技術:即對患者采用氣管插管全麻,取后正中縱行切口,依次切開皮膚、皮下及筋膜,沿白線切開,棘突兩側骨膜下剝離頸后椎旁肌,寰椎向外至后結節(jié)旁開20mm、樞椎向外至關節(jié)突外緣為止,保護靜脈叢、椎動脈及頸2神經(jīng)根。螺釘?shù)倪M釘位置根據(jù)CT選擇在:寰椎為樞椎下關節(jié)突中點的矢狀延長線和寰椎后弓上緣以下約3mm的水平面交點,樞椎為樞椎下關節(jié)突的中點,結合CT數(shù)據(jù)選擇合適螺釘長度,置入直徑為3.5mm的萬向椎弓根螺釘。連接復位棒,復位,固定,沖洗,止血,放置引流管,逐層縫合傷口。結果:1.寰樞椎椎弓根CT測量的結果:寰椎椎弓根的上下徑為(4.45±0.56)mm,寰椎椎弓根的內(nèi)外徑為(8.76±0.73)mm,寰椎椎弓根的上傾角為(7.77±0.62)o,寰椎椎弓根的內(nèi)傾角為(9.13±0.46)o,寰椎椎弓根的長度為(27.88±1.23)mm;樞椎椎弓根的上下徑為(5.09±0.43)mm,樞椎椎弓根的內(nèi)外徑為(6.62±0.46)mm,樞椎椎弓根的上傾角為(40.02±1.25)o,樞椎椎弓根的內(nèi)傾角為(28.43±0.97)o,樞椎椎弓根的長度為(26.64±0.85)mm。2.寰椎椎弓根釘?shù)涝谏蟽A角為最大、最小時,相應的內(nèi)傾角度范圍為(7.1-9.5)°、(7.0-9.4)°,釘?shù)乐行木噱咀禉M突處最大距離分別為4.6mm和4.3mm。3.在50例患者中,共觀察到7例寰椎椎動脈溝環(huán)變異,其發(fā)生率為14.00%,其中后環(huán)變異6側,占總變異率的85.14%,I、II、III、IV型后環(huán)變異發(fā)生率分別為2.00%、1.00%、1.00%、2.00,側環(huán)變異率為1.00%。4.測量結果顯示,寰椎在10°內(nèi)傾角時釘?shù)雷铋L,左右兩側分別為(27.83±1.78)mm和(27.85±1.67)mm;與0°、5°和15°相比無顯著性差異(P0.05)。5.寰椎左右兩側椎弓根不同內(nèi)傾角度進釘時的進釘點至后正中線的距離分析表明,在0°-15°內(nèi),寰椎左右兩側椎弓根進釘?shù)倪M釘點至后正中線的距離呈遞增趨勢,在同一角度下,左右兩側角度其中角度無顯著性差異(P0.05),不同角度間相比具有顯著性差異(P0.05)。6.一年的隨訪,結果顯示患者恢復狀況良好,螺釘無松動變形等狀況產(chǎn)生,50例患者的中優(yōu)良率達96.00%,置釘?shù)臏蚀_率達97.50%。結論:通過對術前CT影像進行觀察和測量,為寰樞椎椎弓根螺釘?shù)臏蚀_置入提供必要的參考和指導,從而進一步提高了寰樞椎椎弓根螺釘技術的安全性和準確性。在手術治療上頸椎損傷中可以獲得滿意的療效,值得廣泛推廣。
[Abstract]:Objective: to provide the reference data for the treatment of the upper cervical spine by the unarmed atlantoaxial pedicle screw placement, and to explore the safety and effectiveness of the unarmed atlantoaxial pedicle screw placement technique by measuring the anatomic structure of the CT images of the atlantoaxial vertebral arch before the operation of the atlantoaxial vertebral pedicle screw. 50 cases of fracture were scanned with CT, and MPR and Inspace software were used to measure the pedicle of atlantoaxial pedicle. The parameters included the upper and lower diameter of the atlantoaxial pedicle, the internal and external diameter of the pedicle, the obliquity of the pedicle, the length of the pedicle, the minimum angle of the nail canal, the maximum obliquity of the nail canal and the best obliquity of the nail canal. By measuring the maximum distance and ideal obliquity of vertebral artery and pedicle at the transverse process of atlas after vertebral arteriography, the abnormality and variation of the ambulation of vertebral artery were found. Fascia, cut along the white line, dissection the posterior cervical paravertebral muscle under the periosteum subperiosteum under the spinous process, the atlas outward to the posterior tubercle to open 20mm, the axis outward to the outer edge of the articular process to protect the venous plexus, the vertebral artery and the 2 nerve root of the neck. The screw position is selected according to CT: the atlas is the sagittal extension line of the middle point of the axis of the axis of the axis and the upper edge of the posterior arch of the atlas. At the horizontal intersection of 3mm, the axis was the middle point of the lower articular process of the axis, combined with the CT data to select the proper length of the screw, and put into the universal pedicle screw with a diameter of 3.5mm. Connecting the reset rod, repositioning, fixing, flushing, hemostasis, placing the drainage tube and suturing the wound by layer by layer. Results: the results of the 1. atlantoaxial pedicle CT measurement: the upper and lower diameter of the atlas pedicle. For (4.45 + 0.56) mm, the internal and external diameter of the pedicle of atlas is (8.76 + 0.73) mm, the obliquity of the pedicle of atlas is (7.77 + 0.62) O, the obliquity of the pedicle of atlas is (9.13 + 0.46) O, the length of the pedicle of atlas is (27.88 + 1.23) mm; the upper and lower diameter of the pedicle of the axis is (5.09 + 0.43), and the internal and external diameter of the pedicle of the axis is (6.62 +) mm, and the pedicle of the axis The obliquity was (40.02 + 1.25) O, and the dips of the pedicle of the axis were (28.43 + 0.97) O, the length of the pedicle of the axis was (26.64 + 0.85) mm.2. of the pedicle of the vertebral arch at the upper dip, and the minimum angle of angle was (7.1-9.5), (7.0-9.4), and the maximum distance between the center of the canal and the transverse process of the atlas was 4.6mm and 4.3mm.3. at 50, respectively. In the patients, 7 cases of atlas vertebral artery trench ring variation were observed, the incidence of which was 14%, of which 6 sides of the posterior ring variation, accounting for 85.14% of the total variation rate, I, II, III, and IV type posterior ring variation were 2%, 1%, 1%, 2 respectively, and the lateral ring variation rate was 1.00%.4., the longest and the left and right sides of the atlas in 10 degrees were the longest and the left and right sides were respectively ( 27.83 + 1.78) mm and (27.85 + 1.67) mm, compared with 0 degrees, 5 degrees and 15 degrees no significant difference (P0.05) the distance between the nail point and the posterior midline of the pedicle of the pedicle in the left and right vertebral arch of the.5. atlas showed that the distance between the entry point of the pedicle of the pedicle of the atlas and the posterior midline of the pedicle of the vertebral arch in the left and right sides of the atlas was increasing, and at the same angle. There was no significant difference in angle between the left and right sides (P0.05), and there was a significant difference between different angles (P0.05).6. one year follow-up. The results showed that the recovery of the patients was good, the screw had no loose deformation and so on. The excellent rate of the 50 patients was 96%, the accuracy of the nail was reached to the 97.50%. conclusion: through the preoperative CT image Observations and measurements provide the necessary reference and guidance for the accurate placement of atlantoaxial pedicle screws, thus further improving the safety and accuracy of atlantoaxial pedicle screw technology. It is worthy of extensive promotion in the surgical treatment of upper cervical spine injury.

【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1809884