目的 测量C2/3经关节突经椎弓根螺钉相关影像学指标，并分析该置钉技术的可行性。 方法 收集120例全颈椎CT薄层扫描数据，其中男性75例，女性45例。设定C2/3经关节突经椎弓根螺钉的进钉点，即进钉点在枢椎侧块的水平中线与中外1/3垂线交点处，螺钉自枢椎侧块穿C2/3关节突关节、C3侧块止于C3椎弓根下缘。测量C2/3经关节突经椎弓根螺钉相关影像学数据，包括C3椎弓根宽度与高度，螺钉通道长度，内倾角度，头倾角度，最狭窄处宽度。并分析各项测量结果之间的关系。 结果 C3椎弓根平均宽度5.48 mm，平均高度6.82 mm，螺钉通道平均长度18.68 mm，平均内倾角度20.46°，平均头倾角度50.1°，最狭窄处平均宽度2.80 mm。C3椎弓根宽度与高度呈正相关（P=0.000），螺钉通道长度与C3椎弓根宽度、高度呈正相关（P=0.000；P=0.000），螺钉通道最狭窄处宽度与C3椎弓根宽度、高度呈正相关（P=0.000；P=0.000）。240例置钉测量数据中，如使用3.5 mm直径螺钉，均可完成置钉，C2/3经关节突经椎弓根螺钉适用于所有患者。 结论 C2/3经关节突经椎弓根螺钉在解剖学上是可行的，可作为上颈椎后路钉棒内固定补充的置钉技术。
Abstract
Objective To measure the imaging indexes of C2/3 transarticular transpedicular screw, and analyze the feasibility of this screw placement technique. Methods The CT data of 120 thin slice CT scan were collected, including 75 males and 45 females. The entry point of the C2/3 transarticular transpedicular screw was set, that is, the entry point was at the intersection of the horizontal midline and the mid-lateral 1/3 vertical line of the lateral mass of the axis. The screw passed through the facet joint of C2/3 and the C3 lateral mass, from the lateral mass of the axis, and ended at the inferior edge of the pedicle of C3. The imaging data of C2/3 transarticular transpedicular screw were measured, including C3 pedicle width and height, screw channel length, introversion angle, head tilt angle and the narrowest width. The relationship between the measurement results was analyzed. Results The average width of C3 pedicle was 5.48mm, the average height was 6.82 mm, the average screw channel length was 18.68mm, the average introversion angle of screw channel was 20.46 °, the average head tilt angle was 50.1°, and the average width of the narrowest part was 2.80 mm. There was a positive correlation between C3 pedicle width and height (P=0.000). The length of screw channel was positively correlated with C3 pedicle width and height (P=0.000; P=0.000 ). The width of the narrowest part of screw channel was positively correlated with C3 pedicle width and height (P=0.000；P=0.000). In the measurement data of 240 cases, the screw placement could be completed if 3.5 mm diameter screws were used, and the screw was suitable for all patients. Conclusions C2/3 transarticular transpedicular screw is anatomically feasible and can be used as a supplementary technique for posterior screw rod internal fixation of upper cervical spine.
关键词
枢椎； /
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影像学测量； /
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C2/3经关节突经椎弓根螺钉
Key words
Axis； /
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Imaging measurement； /
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C2/3 transarticular transpedicular screw
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基金
广州市科技计划项目（201803010046）；国家自然科学基金（82272582）
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