摘要
目的:测量下颈椎关节突关节的相关数据,探讨其与经关节螺钉固定的关系。方法:41具成人颈椎干燥标本,测量其颈椎关节突关节的上、下关节面的高度、宽度和冠状面角度以及下关节面在侧块后方投影的高度,并对侧块进行形态学评定;根据Dalcanto技术对30具颈椎标本行经关节突关节螺钉固定,以侧块中心点下2mm为进钉点,在矢状面上尾倾40°、在冠状面上外倾20°置入螺钉,测量螺钉的长度,观察螺钉位置。结果:C3～C7下关节面在侧块后方投影的高度为7.4～9.0mm,侧块的中心点约在下关节面后方投影的上界下方2mm。C6和C7上、下关节面的倾斜角度相对更大,侧块厚度相对较薄。采用Dalcanto技术经关节突关节螺钉固定,螺钉长度从C3/4向C7/T1呈下降趋势,由16.9mm降至15.7mm,其中在C7/T1水平螺钉最短。螺钉由头侧向尾侧经关节突关节复合体,大体上从关节面的中心点穿过;在矢状面上几乎与关节面垂直;无一例损伤到横突孔,螺钉从下位椎体的上关节突基底部的侧前方穿出,钉道指向侧前下方。结论:下颈椎关节突关节复合体可为经此关节螺钉固定提供足够的皮质骨。Dalcanto技术经关节突关节螺钉不仅具有可行性,而且可以避开横突孔,钉道方向几乎与横突沟平行,安全空间较大。由于C6、C7侧块的厚度较薄,在C6/7和C7/T1行经关节固定时不宜使用16mm以上长度的螺钉。
Objective：To quantitatively evaluate the subaxial cervical facet and analyze its relationship with the transarticular screw instrumentation.Method：41 human cervical spines from C3 to C7 were directly evaluated.Anatomic evaluation of the cervical superior and inferior facets included the facet height,width, and angulation relative to the coronal plane.The projection of the inferior facet on the posterior aspect of the lateral mass was constructed and measured,and the dimensions of the lateral mass were evaluated.The Dalcanto transarticular screw technique was performed in this study in 30 cervical spines.The anchoring point for screw insertion located 2mm caudal to the midpoint of the lateral mass and the orientation of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane.After screws were inserted,the screw length was measured and the position of the transarticular screws was observed.Result：The posterior projection height of the inferior facet at C3-C7 averaged 7.4-9mm.The midpoint of the lateral mass was 2mm inferior to the superior margin of the inferior facet projection height.C6 and C7 superior and inferior facet had relative larger angles,and the lateral mass was thinner at the level of C6 and C7.The length of the Dalcanto transarticular screw decreased from C3/4 to C7/T1,averaglng 15.7-16.9mm,with the shortest length at C7/T1.The screws from caudally to cephalically perforated the facet complex, almost through the midpoint of the facet, vertical to the facet in the sagittal plane,without violation of the transverse foramen.The exit point of the transarticular screws lied below the base of the anterolateral corner of the superior articular process,and the screw＇s trajectory points inferiorly and anterolaterally.Conclusion：There are enough cortex in the facet complex for placing tansarticular screws in the lower cervical spine.The Dalcanto transarticular screw technique not only has the feasibility,but also has a great safety margin because the screws trajectory can avoid the transverse foramen, and almost parallel the the transverse process.As the lateral mass was thinner at the level of C6 and C7,the length of screws should not be longer than 16mm at C6/7 and C7/T1.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2007年第2期140-144,共5页
Chinese Journal of Spine and Spinal Cord
基金
宁波市社会发展攻关项目(项目编号:2006C100061)
关键词
解剖学
颈椎
关节突关节
经关节螺钉
Anatomy
Cervical vertebrae
Facet joint
Transarticular screws
