测量成人寰枢椎后方部分结构数据设计寰枢椎板

背景：寰枢椎融合器一直以侧块关节融合器为研究热点，但其置入操作风险过大，目前临床上一直缺乏可广泛应用的寰枢椎融合器。

目的：探究成人后路寰枢椎板间融合器的CT 影像解剖学可行性并给出初步设计。

方法：对100 例成人(男50 例，女50 例)寰枢椎CT 三维成像进行测量，测量指标包括寰椎单侧后弓长度、寰椎后弓厚度、枢椎单侧椎板长度、枢椎椎板厚度、寰椎后弓上缘至枢椎椎板下缘距离，分析寰枢椎后方部分结构的CT 测量数据并设计寰枢椎板间融合器。

结果与结论：①男、女性的寰椎单侧后弓长度分别为(23.) mm 和(22.) mm，寰椎后弓厚度分别为(6.) mm 和(5.) mm，枢椎单侧椎板长度分别为(18. )mm 和(17.) mm，枢椎椎板厚度分别为(5.) mm 和(4.) mm，寰椎后弓上缘至枢椎椎板下缘距离分别为(32.) mm 和(31.) mm；②不同性别的双侧测量数据差异无显著性意义(P> 0.05)；男性的寰椎单侧后弓长度、寰椎后弓厚度、枢椎单侧椎板长度大于女性，差异有显著性意义(P< 0.05)；男性与女性的枢椎椎板厚度、椎后弓上缘至枢椎椎板下缘距离差异无显著性意义(P> 0.05)；③寰枢椎后方部分结构的CT 测量结果提示寰枢椎板间融合器是可行的；④寰枢椎板间融合器初步设计成功，并获得国家专利；⑤提示寰枢椎板间融合器具有应用可行性，可用于寰枢椎后路钉棒固定融合过程中，提升寰枢椎间的植骨融合率。

BACKGROUND:Atlantoaxial lateral mass joint fusion cage has always been a focus of research, but its implant operation is too risky.At present, there is no widely used atlantoaxial fusion cage.

OBJECTIVE:To investigate the anatomical feasibility of CT image and preliminary design of posterior atlantoaxial interlaminar fusion cage in adults.

METHODS:Measurement of atlantoaxial three-dimensional CT of 100 adult cases (50 males and 50 females) was performed, including C1unilateral posterior arch length, C1posterior arch width, C2unilateral lamin length, C2lamina thickness and the distance of C1posterior arch higher edge to C2lamin lower edge.CT measurement data of posterior part of atlantoaxial structure were analyzed, and atlantoaxial interlaminar fusion cage was designed.

RESULTS AND CONCLUSION:(1) The C1unilateral posterior arch length of man and woman was (23.) mm and (22.) mm respectively, and the C1 posterior arch width was (6.) mm and (5.) mm respectively, and the C2unilateral lamin length was (18.) mm and (17.) mm respectively, and the C2lamina thickness was (5.) mm and (4.) mm, distance of C1posterior arch higher edge to C2lamin lower edge was (32.) mm and (31.) mm, respectively.(2) There were no statistically significant differences in the bilateral measurement data of different genders (P> 0.05).The C1unilateral posterior arch length, C1posterior arch width and C2unilateral lamin length in men were larger than those in women, and the differences were statistically significant (P< 0.05).There were no statistically significant differences in the C2lamina thickness and the distance of C1posterior arch higher edge to C2lamin lower edge of different genders (P> 0.05).(3) CT measurement data suggested that atlantoaxial interlaminar fusion cage is feasible.(4) Preliminary design of atlantoaxial interlaminar fusion cage was successful, and obtained the national patent.(5) It is suggested that atlantoaxial interlaminar fusion cage has application feasibility and can be used in posterior atlantoaxial screw-rod fixation and fusion to improve the fusion rate of bone graft.

0 引言 Introduction

目前，脊柱椎间融合器已广泛应用于颈胸腰椎的固定融合过程中，明显提高了椎体间植骨融合率，同时有效地减少了单纯固定、单纯植骨所带来的一系列相关临床并发症[1-2]。但对于寰枢椎融合术，由于结构的特殊性、毗邻结构的复杂性、手术的高风险性，临床上一直无可靠的融合器以供使用，仍延续传统的单纯植入自体骨的方式[3]。虽国内外有较多的学者对寰枢椎融合器进行了设计研究，但因置入困难、风险高、技术难度大等原因，未能获得广泛应用[2-5]。后路钉棒系统固定仍为现今应用最为广泛的寰枢椎固定术式[8-17]，此次研究拟通过寰枢椎后方部分解剖结构的CT测量研究，设计一款可配后路钉棒系统的寰枢椎板间融合器，以期提高寰枢椎后路固定融合术的植骨融合率。

1 对象和方法 Subjects and methods

1.1 设计 影像学测量试验。

1.2 时间及地点 于2016年12月至2017年6月在中国人民解放军南部战区总医院骨科医院脊柱外科完成。

1.3 对象 从中国人民解放军南部战区总医院骨科医院医学影像科阅片系统中随机抽取100例(男50例，女50例)成人薄层扫描寰枢椎CT三维成像影像资料，年龄18-70岁，平均43岁，入组男、女性在年龄上差异无显著性意义(P> 0.05)。试验方案得到中国人民解放军南部战区总医院伦理委员会批准，并取得所有患者的知情同意。

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