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目的对寰椎侧块螺钉和寰椎椎弓根螺钉进行解剖和生物力学研究,为临床选择寰椎螺钉的固定方式提供依据。方法利用12例新鲜标本的寰椎进行单皮质和双皮质的椎弓根螺钉或侧块螺钉固定,测试比较其螺钉拔出强度和钉道长度。结果寰椎椎弓根螺钉的最大进钉长度为29·79mm±1·68mm,其中10·15mm在寰椎后弓内,19·65mm在寰椎侧块内。寰椎侧块螺钉的最大进钉长度为24·88mm±0·41mm,其进钉点与寰椎后弓后缘的平均距离为9·93mm±1·35mm。双皮质寰椎椎弓根螺钉的拔出力量最大,平均1757·0N±318·7N;单皮质寰椎椎弓根螺钉(1192·5N±172·6N)与双皮质寰椎侧块螺钉(1243·8N±350·0N)无明显差异,单皮质寰椎侧块螺钉最小(794·5N±314·8N)。结论在同时适用寰椎椎弓根螺钉和寰椎侧块螺钉固定的患者,宜首先选择寰椎椎弓根螺钉固定,次选寰椎侧块螺钉固定。
Objective To study the anatomy and biomechanics of atlas lateral mass screw and atlas pedicle screw and provide the basis for the clinical choice of atlas screw fixation. Methods Twelve fresh specimens of atlas were used for the fixation of unicortical and bicortical pedicle screws or lateral block screws. The screw extraction strength and the length of the screw were measured. Results The maximum pedicle screw length of atlas pedicle screw was 29.79mm ± 1.68mm, of which 10 · 15mm was in the posterior arch of the atlas and 19.65mm in the lateral mass of the atlas. The maximal nailing length of atlas lateral mass screw was 24.88mm ± 0.41mm, and the average distance between the entry point and posterior edge of atlas posterior arch was 9.93mm ± 1.35mm. The maximum cortical atlas pedicle screw extraction strength was 1757 · 0N ± 318 · 7N; · 8N ± 350 · 0N) no significant difference in the corticocelar atlas lateral mass screw the smallest (794 · 5N ± 314 · 8N). Conclusions In patients with atlas pedicle screw fixation and atlas lateral mass screw fixation, atlas pedicle screw fixation should be the first choice and atlas lateral mass screw fixation should be the second choice.