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目的:为经口前路进行寰枢椎钢板内固定手术提供解剖基础。方法:新鲜冰冻尸头标本6个,头颈部标本30个模拟经口入路手术过程,逐层解剖至上颈髓,观察并测量手术入路上的径向、轴向及水平方向的重要结构及解剖数据。寰枢椎干骨标本30个,对与内固定相关的骨性参数进行测量。结果:经口入路至颈髓的操作深度最大(103.8±6.2)mm,可显露范围长(52.1±3.5)mm,宽(39.4±2.2)mm,手术安全范围由双侧椎动脉构成,呈一不规则的倒置梯形,其边界在C2/3横突间距离中线仅(11.4±1.4)mm,故在此区域操作时应十分小心。寰椎理想进钉点距离中线(15.0±2.0)mm,理想钉道角度(12.5±2.5)°,理想钉道深度(20.8±1.5)mm。结论:经口前路钢板内固定手术是安全可行的,主要手术操作区域中双侧椎动脉内缘位于显露范围之外,钢板宽度应介于20～42 mm,寰椎螺钉长度不宜超过18 mm。
Objective: To provide anatomical basis for anterior approach to atlantoaxial plate fixation. Methods: Six fresh frozen cadaver specimens, 30 head and neck specimens were simulated by oral surgery and dissected to the upper cervical cord layer by layer. The radial, axial and horizontal important structures of the surgical approach were observed and measured. Anatomical data. Atlantoaxial skeletal specimens of 30, with the internal fixation related to the measurement of bone parameters. Results: The maximum depth of operation (103.8 ± 6.2) mm and the range of 52.1 ± 3.5 mm (39.4 ± 2.2) mm and width (39.4 ± 2.2) mm were revealed. The safe range of operation was bilateral vertebral artery An irregular inverted trapezoid whose boundary is only (11.4 ± 1.4) mm from the midline of the C2 / 3 transverse process should be treated with care in this area. The mean diameter of atlas vertebrae was (15.0 ± 2.0) mm, the ideal angle (12.5 ± 2.5) ° and the ideal nail depth (20.8 ± 1.5) mm. Conclusions: Anterior transluminal plate fixation is safe and feasible. The inner edge of the bilateral vertebral artery in the main surgical operation area is outside the exposed range. The width of the plate should be between 20 and 42 mm. The length of the atlas should not exceed 18 mm .