颈椎单开门椎管扩大成形椎板重建(钛板)固定的应用解剖

摘要/Abstract

摘要：

目的　为颈椎单开门椎管扩大成形椎板重建(钛板)固定提供解剖学参数。方法　采用50套正常成人干燥颈椎骨标本测量C3～7的相关参数，进行统计学分析。结果　侧块宽度C3(9.89±0.97)　mm，C7(12.09±0.93)mm、高度C4(11.44±2.09)mm，C7(13.56±2.17)mm,逐渐增大。侧块厚度C3(9.03±1.46)　mm、C7(6.66±0.78)mm，逐渐减小。自侧块外缘至棘突基底部上5 mm之间的长度C3(25.21±2.08)mm，C6(27.09±1.80)mm，C7与C4接近。椎板外侧端、中间的高度分别为C3(11.54±1.66)mm，C7(16.83±1.77)mm；C3(10.91±1.58)mm，C7(14.86±1.48)mm,逐渐增大。椎板外侧端、中间的厚度分别为C5(4.44±0.81)mm、C7(5.28±0.76)mm；C4(3.00±0.86)mm，C7(4.92±0.96)mm。棘突基底部的高度C4(9.33±1.67)mm、C7(11.34±1.57)mm、基底部上5 mm平面的高度C4(7.10±1.76)mm, C7(9.82±1.46)mm,C3与C5接近。棘突基底部的宽度C5(8.59±　1.81)mm,C7(11.13±1.76)mm、上5 mm平面的宽度C5(6.66±1.86)mm,C7(8.50±1.58)mm，C5最小，C7最大。结论　颈椎单开门椎管扩大成形椎板重建(钛板)固定在形态学上有可行性，能扩大椎管、重建颈椎板的稳定性。

关键词: 应用解剖, 微型钛板, 内固定, 单开门椎管扩大成形术

Abstract:

Objective　To provide anatomic parameters for the cervical unilateral open-door laminoplasty with reconstruction lamina(titanium miniplate) fixation.　Methods　50 sets of dry cervical vertebrae specimens were observed in this study. The width, height and thickness of lateral masses(LMW, LMH, LMT), the surface length from the external border of lateral masses to the plane of 5mm above the basilar part of spinal process(LSL), the height and thickness of the lateralis and median part of laminar(LH1, LH2, LT1,LT2), the height and width of the basilar part of spinal process(SPH1,SPW1) and the plane of 5 mm above the basilar part of spinal process(SPH2,SPW2) were measured and analyzed. 　Results　 LMW was about C3(9.89±0.97)mm, C7(12.09±0.93)mm. LMH C4(11.44±2.09)mm, C7(13.56±2.17)mm, which was linear correlated, increased gradually. LMT C3(9.03±1.46)mm and C7(6.66±0.78)mm, which decreased gradually. LSL C3(25.21±2.08)mm, C6(27.09±1.80)mm, C7 and C4 was similar. LH1 C3(11.54±1.66)mm, C7(16.83±1.77)mm and LH2 C3(10.91±1.58)mm, C7(14.86±1.48)mm, increased gradually. LT1 C5(4.44±0.81)mm, C7(5.28±0.76)mm and LT2 C4(3.00±0.86)mm, C7(4.92±0.96)mm. SPH1 C4(9.33±1.67)mm, C7(11.34±1.57)mm and SPH2 C4(7.10±1.76)mm, C7(9.82±1.46)mm, C3 and C5 was similar. SPW1 C5(8.59±1.81)mm, C7(11.13±1.76)mm and SPW2 C5(6.66±1.86)mm, C7(8.50±1.58)mm, which was the shortest in C5, the longest in C7.　Conclusions　Cervical unilateral open-door laminoplasty with reconstruction lamina (titanium miniplate) fixation is feasible anatomically. It can enlarge cervical vertebral canal and reconstruct the stability of lamina.

Key words: Applied anatomy, Titanium miniplate, Internal fixation, Unilateral open-door laminoplasty

中图分类号:

R681.5

孙　进, 闵少雄, 黄小军, 安树康, 刘　阳, 周初松. 颈椎单开门椎管扩大成形椎板重建(钛板)固定的应用解剖[J]. 中国临床解剖学杂志, 2011, 29(3): 272-274.

SUN 　Jin, MIN Shao-Xiong, HUANG Xiao-Jun, AN Shu-Kang, LIU 　Yang, ZHOU Chu-Song. Applied anatomy of cervical unilateral open-door laminoplasty with reconstruction lamina (titanium miniplate) fixation[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(3): 272-274.

参考文献

[1] Kawaguchi Y,Kanamori M,Ishihara H,et al.Minimum 10-year follow-up after en bloc cervical laminoplasty
[J].Clin Orthop Relat Res,2003,411(6):129-139.

[2] Shaffrey CI,Wiggins GC,et al.Modified open-door laminoplasty for the treatment of neurological deficits in younger patients with cations through careful preoperative congenital spinal stenosis: Analysis of clinical and radiographic data
[J].J Neurosurg,1999,90(2 Suppl):170-177.

[3] Andrew E. Park,John G. Heller.Cervical Laminoplasty: Use of a Novel Titanium Plate to Maintain Canal Expansion-Surgical Technique
[J].J Spinal Disord Tech, 2004,17(4):265-271.

[4] Hirabayashi K,Watanabe K,Wakano K,et al.Expansive open-door laminoplasty for cervical spinal stenotic myelopathy
[J].Spine,1983,8(7):693-699.

[5] Chiba K,Ogawa Y,Ishii K,et al.Long-term results of expansive open-door laminoplasty for cervical myelopathy:average 14-year follow-up study
[J].Spine,2006,31(26):2998-3005.

[6] Itoh T,Tsuji H.Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine
[J].Spine,1985,l0(8):729-736．

[7] 郑和平,陈振光,张发惠，等.以颈横动脉深支为蒂肩胛内侧骨瓣椎板成形术的应用解剖
[J].中国临床解剖学杂志,1995,13(2):97-99.

[8] Wang JM,Roh KJ,et al.A new method of stabilizing the elevated laminae in open-door laminoplasty:using an anchor system
[J].J Bone Joint Surg（Br）,1998,80(6):1005-1008.

[9] 孙宇.关于轴性症状
[J].中国脊柱脊髓杂志,2008,18(4):289.

[10] 张学利,夏英鹏,贾宇涛，等. FASTIN锚钉在颈椎单开门椎管成形术中的应用
[J].中国矫形外科杂志,2009,17(4):256-259.

[11]Liu B,Tian W,Wang YQ,et al.Cervical posterior laminoplasty operation using coralline hydroxyapatite
[J].Zhonghua Wai Ke Za Zhi,2005,43(12):766-769.

[12]Kihara S,Umebayashi T,Hoshimaru M.Technical improvements and results of open-door expansive laminoplasty with hydroxyapatite implants for cervical myelopathy
[J].Neurosurgery,2005,57(4 Suppl):348-356.

[13]Hosono N,Sakaura H,Mukai Y,et al.En bloc laminoplasty without dissection of paraspinal muscles
[J].J Neurosurg Spine,2005,3(1):29-33.

[14]田长庆,李振宇,顾洪生，等.高龄颈椎管狭窄症手术治疗的临床研究
[J].中国临床解剖学杂志,2008,26(5):571-573.

[15]Heller JG,Estes BT,Zaouali M,et al.Biomechnical study of screws in the lateral masses:variables affecting pull-out resistance
[J].J Bone Joint Surg(Am),1996，78(9):1315-1321.