儿童枢椎椎弓根及椎板螺钉内固定的解剖学研究

摘要

Objective To investigate the feasibility for internal fixation of pedicle screw and laminar screw in the axis of children. Methods Thirty-two sets of cervical CT scan images of children (age range from 2 to 10 years old) treated in Guangzhou General Hospital of Guangzhou Military Command from 2009 to 2012 were slected, in which there were 16 sets (32 sides) in play age group (age range from 2 to 5 years old ) and other 16 sets (32 sides) in primary school-age group (age range from 5 to 10 years old). The axial pedicle width, length and introvert angle of pedicle screw trajectory, as well as the isthmus width of lamina, length and outward angle of laminar screw trajectory were measured by PACS tools respectively. Results There were 15 sides where pedicle width of pedicle screw trajectory > 3.5 mm in play age group and 26 sides in primary school-age group;while 24 sides where isthmus width of laminar screw trajectory > 3.5 mm in play age group and 31 sides in primary school-age group. Differences of average width, length of pedicle and larmina all showed statistical significance between 2 groups (P <0.05), as for introvert angle of pedicle screw trajectory and outward angle of laminar screw trajectory, there had no statistical differences between 2 groups (P >0.05). Conclusions It is mostly feasible for axis pedicle screw and laminar screw implant for primary school-age children. For the play age children, based on preoperative accurate measurement and evaluation of relative screw implant anatomic parameters through thin slice cervical CT scan images, laminar or pedicle screw or mixed internal fixation should be chosen reasonably so as to provide safe and efficient fixation.%目的：探讨儿童枢椎椎弓根及椎板螺钉内固定的可行性。方法收集2009年至2012年广州军区广州总医院儿童颈椎薄层CT影像资料32套，其中年龄2～5岁（幼龄组）及5～10岁（学龄组）各16套32侧。测量枢椎椎弓根虚拟钉道宽度、长度、内倾角，椎板虚拟钉道峡部宽度、长度及外展角数据。结果幼龄组椎弓根虚拟钉道宽度＞3.5 mm为15侧、学龄组为26侧；幼龄组椎板虚拟钉道峡部宽度＞3.5 mm为24侧、学龄组为31侧。两组比较，差异均有统计学意义（P＜0.05）。幼龄组和学龄组椎弓根虚拟钉道平均宽度、平均长度，椎板虚拟钉道峡部平均宽度、平均长度比较，差异均有统计学意义（P＜0.05）；两组椎弓根虚拟钉道内倾角、椎板虚拟钉道外展角比较，差异无统计学意义（P＞0.05）。结论对于5～10岁的学龄期儿童，可根据情况选用枢椎椎弓根螺钉或椎板螺钉内固定方式；而对于年龄＜5岁的低龄患儿，术前需基于患儿颈椎薄层CT扫描螺钉内固定相关解剖参数的精确测量和评估，合理选择枢椎椎弓根螺钉、椎板螺钉或混搭式固定，以保证手术的安全性和内固定的可靠性。