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目的:为寰椎侧块后路螺钉固定提供解剖学依据。方法:对３０例中国成年人的寰椎干骨标本具有临床意义的数据进行解剖学测量,同时对６例新鲜颈椎尸体标本的后人路颈２神经根与寰椎侧块的关系进行观察。结果:寰椎中线至侧块中点、椎动脉内侧壁、椎弓根内缘的距离分别为:(１７．５６±１．１８)ｍｍ、(２３．０４±１．６９)ｍｍ及(ｌ４．１８±１．０７)ｍｍ;侧块中部的宽度为(１１．５９±１．３９)ｍｍ,侧块中心点的厚度为(１２．７０±１．０４)ｍｍ;后弓与侧块移行处中点至下关节面间距为(４．０８±０．６９)ｍｍ;椎动脉沟处后弓厚度为(４．７０±１．００)ｍｍ。解剖学观察见颈２神经根出脊髓后沿颈１/２关节间隙的下方向外下行走,且颈２神经根有较大的移动度。结论:寰椎侧块较枢椎椎弓根明显宽大,颈２神经根的上方有足够的空间,故认为寰椎侧块后路螺钉固定是完全可行的。螺钉的进钉方向矢状面应向上２０°,横断面上应向内斜１５°,螺钉在侧块内的长度约２２ｍｍ。
Objective: To provide anatomical basis for posterior screw fixation of atlas lateral mass. Methods: The data of clinical significance of atlantoaxial bone specimens of 30 Chinese adults were anatomically measured. The relationship between the posterior cervical 2 nerve root and the lateral mass of atlas were observed in 6 cases of fresh cervical cadaver specimens. Results: The distance from the midline of atlas to the midpoint of lateral mass, the medial wall of vertebral artery and the inner edge of pedicle were (17.56 ± 1.18) mm, (23.04 ± 1.69) mm and (14 .18 ± 1.07) mm. The width of the middle part of the lateral mass was (11.59 ± 1.39) mm and the thickness of the central mass of the lateral mass was (12.70 ± 1.04) mm. The distance between the midpoint and the inferior articular surface was (4.08 ± 0.69) mm. The thickness of the posterior arch of the vertebral artery was (4.70 ± 1.00) mm. Anatomical observation of the cervical 2 nerve root out of the spinal cord following the neck 1/2 below the joint space under the walk, and neck 2 nerve root greater mobility. Conclusion: The lateral mass of atlas is obviously wider than that of the pedicle of vertebral arch, and there is sufficient space above the nerve root of the neck. Therefore, it is feasible to fix the posterior screw of atlas lateral mass. Screw into the screw direction sagittal plane should be up 20 °, the cross-section should be inward oblique 15 °, the length of the screw in the side block of about 22mm.