寰椎前弓双皮质螺钉固定相关解剖学测量

Anatomical measurement of bicortical C1 anterior arch screw fixation

中文关键词:  寰椎前弓  测量  骨脊柱重建  双皮质可调螺钉

英文关键词:Anterior arch of atlas  Measurement  Bone spine reconstruction  Adjustable bicortical screw

中文摘要:

  【摘要】 目的：通过测量寰椎前弓双皮质螺钉固定相关解剖结构数据，为设计出更契合寰椎解剖结构的双皮质可调螺钉提供可靠的数据支持。方法：回顾性分析2017年4月~2018年8月门诊及住院部行上颈椎CT三维重建检查的就诊患者99例。其中男性54例，年龄31~81岁，平均56.67±10.56岁，身高159~180cm，平均172.24±4.95cm，体重55~90kg，平均70.24±7.57kg；女性45例，年龄46~77岁，平均59.84±8.29岁，身高154~171cm，平均163.11±5.24cm，体重40~80kg，平均59.31±8.48kg。通过三维测量软件，对前结节中点与齿状突后缘中点距离（前后距离）、双侧垂直钛板螺钉孔方向置钉长度（垂直长度）、双侧向齿状突后缘中点方向置钉长度（斜行长度）、双侧向齿状突后缘中点方向置钉尾端外倾角度（尾端外倾角度）和双侧置钉处前弓高度等进行测量。按照不同性别将患者分组，两组定量资料的比较采用t检验（方差齐）或Satterthwaite t′检验（方差不齐）；左右侧比较采用配对t检验。年龄和各数值的相关性采用简单线性回归分析，身高、体重和各数值的关系采用Pearson相关系数和简单线性回归描述。结果：垂直长度、斜行长度、尾端外倾角度及置钉处前弓高度的左右侧数值差异均无统计学意义（P>0.05）。男性前后距离、垂直长度、斜行长度、尾端外倾角度、置钉处前弓高度的均数分别为21.33±1.12mm、8.92±1.48mm、8.37±1.49mm、13.20°±0.93°、12.44±0.48mm；女性前后距离、垂直长度、斜行长度、尾端外倾角度、置钉处前弓高度的均数分别为20.01±1.33mm、8.18±1.56mm、7.67±1.58mm、13.88°±1.38°、12.08±0.75mm；男性患者垂直长度、斜行长度、前后距离及置钉处前弓高度大于女性患者，女性患者尾端外倾角度大于男性患者，有统计学意义（P<0.05）。身高和垂直长度及斜行长度在不同性别组中均无相关性（P>0.05）。Pearson相关分析显示，身高和尾端外倾角度在不同性别组中均呈负相关（r=-0.123，P<0.05）。年龄和各数值的相关性没有统计学意义（P>0.05）。结论：男性患者垂直长度、斜行长度、前后距离及置钉处前弓高度大于女性患者，女性患者尾端外倾角度大于男性患者。术者可根据患者性别，参考所得置钉参数选择合适的螺钉，从而提高了寰椎前弓置钉的准确率和安全性。

英文摘要:

  【Abstract】 Objectives: To guide the insertion of the atlantoaxial bicortical screw by measuring the anatomical structure of the atlantoaxial anterior arch bicortical screw fixation, so as to provide reliable data for the design of bicortical adjustable screw that fits the atlas anatomy. Methods: 99 three-dimensional(3D) CT reconstructions of upper cervical spine of the patients in the outpatient service and the inpatient department from April 2017 to August 2018 were reviewed and analyzed. There were 54 males aged 31-81 years old(average 56.67±10.56 years old), height 159-180cm(average 172.24±4.95cm), weight 55-90kg(average 70.24±7.57kg), 45 females aged 46-77 years old(average 59.84±8.29 years old), height 154-171cm(average 163.11±5.24cm), weight 40-80kg(average 59.31±8.48kg). Through the three-dimensional measurement software, the distance between the midpoint of anterior nodule and the midpoint of posterior margin of the odontoid(DAP), the length of bilateral vertical titanium plate screw in the vertical direction(LVD), the length of bilateral vertical titanium plate screw in direction toward the midpoint of the odontoid posterior margin(DMOP), the tail extraversion angle of screw toward the midpoint of the odontoid posterior margin(TEA) was measured and the height of bilateral anterior arch in placing screw of the atlas(HAA) was measured. Patients were divided into groups according to gender. The quantitative data of different groups were compared by t test (homoscedasticity) or Satterthwaite t′ test (heteroscedasticity); the paired t test was used for the comparison of left and right sides. Simple linear regression was used to analyze the relationship between age and previous measurements. In addition, Pearson correlation coefficient and simple linear regression were used to analyze the relationship between height, weight and previous measurements. Results: The numerical differences of the symmetrical sides of LVD, DMOP, TEA and HAA were not statistically significant(P>0.05). The average measured data of DAP, LVD, DMOP, TEA, HAA in male group were 21.33±1.12mm, 8.92±1.48mm, 8.37±1.49mm, 13.20°±0.93° and 12.44±0.48mm respectively. The average measured data of DAP, LVD, DMOP, TEA, HAA in female group were 20.01±1.33mm, 8.18±1.56mm, 7.67±1.58mm, 13.88°±1.38° and 12.08±0.75mm respectively. Moreover, compared to female patients, male patients showed larger DAP, LVD, DMOP and HAA. In contrast, TEA of the female patients was larger than that of the male patients, which was statistically significant(P<0.05). However, there was no statistically significant correlation between height of patient and LVD as well as DMOP in both groups(P>0.05). Pearson correlation analysis showed that there was a significant negative correlation between the height and TEA in both groups(r=-0.123, P<0.05). There was no statistically significant correlation between age and other parameters(P>0.05). Conclusions: Compared to female patients, male patients show greater DAP, LVD, DMOP and HAA. In contrast, TEA of the female patients is larger than that of the male patients, which is statistically significant. According to the patient′s gender and related parameters, the surgeon can select the appropriate screw to improve the accuracy and safety of the screw placing into the anterior arch of atlas.