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目的:研究寰枢关节后部的神经血管丛与寰椎椎弓根的解剖关系,为局部手术显露和寰椎椎弓根螺钉固定提供依据。方法:利用2具血管灌注的颈椎标本,解剖观测寰枢后部的神经血管丛及其与寰枢椎的关系。在20具尸体标本上利用枢椎侧块定位方法,不分离寰枢神经血管丛,直接进行寰椎椎弓根螺钉固定,而后X线和CT扫描评价螺钉位置情况。结果:在寰枢关节的后方有丰富的、怒张的球团状的静脉丛存在,分离时易出现血管壁损伤。模拟临床手术共完成40枚寰椎椎弓根螺钉固定,无脊髓、硬膜、椎动脉、脊神经损伤,X线和CT扫描显示所有螺钉位置理想。结论:寰椎椎弓根螺钉固定时不宜分离显露寰枢神经血管丛,而枢椎侧块定位方法可以满足这一要求。
OBJECTIVE: To study the anatomic relationship between the posterior atlantoaxial vascular plexus and the atlas pedicle, and to provide evidence for the local surgical findings and atlas pedicle screw fixation. Methods: Cervical spondylolisthesis with 2 vessels was used to dissect the posterior atlantoaxial nerve plexus and its relationship with atlantoaxial spine. Axial lateral mass localization was performed on 20 cadaver specimens, and atlantoaxial pedicle screw fixation was performed without separation of atlantoaxial vascular plexus. X-ray and CT scans were performed to evaluate the position of the screw. Results: In the rear of the atlantoaxial joint, there are abundant and engorgement of pelvic veins, and vascular wall injury easily occurs when they are separated. A total of 40 atlas pedicle screw fixation were performed in simulated clinical surgery without spinal cord, dura mater, vertebral artery and spinal nerve injury. X-ray and CT scan showed that all screw positions were ideal. Conclusion: Atlantoaxial pedicle screw fixation should not be used to separate and expose the atlantoaxial vascular plexus, while the lateral mass positioning method can meet this requirement.