寰椎前路锁定加压钢板的设计
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摘要
背景:目前缺乏经口咽入路单节段固定治疗寰椎骨折的内固定钢板。目的:结合临床实际需求,系统收集寰椎形态学数据,研制寰椎前路锁定加压钢板。方法:用PACS系统影像工作站及CT自带影像处理工作站,测量96例正常成年人寰椎相关解剖参数,包括寰椎前弓宽度、寰椎前结节高度、侧块长度、寰椎前弓长度、侧块中点高度、寰椎侧块外倾角α、寰椎前弓弧度θ及咽后壁软组织间隙。采用SPSS18.0统计软件对所得数据进行统计分析,提供可靠的形态学数据,根据解剖数据及临床要求设计寰椎前路锁定加压钢板。结果与结论:(1)测得寰椎前弓宽度为(8.85±1.47)mm,寰椎前结节高度为(12.49±2.28)mm,侧块长度为(20.14±1.54) mm,寰椎前弓长度为(39.68±2.29) mm,侧块中点高度为(9.98±1.48) mm,寰椎侧块外倾角α为(13.92±1.90)°,寰椎前弓弧度θ为(147.32±4.53)°,咽后壁软组织间隙为(3.12±0.49) mm;(2)寰椎前路锁定加压钢板成功设计,并获得国家专利;(3)提示寰椎前路锁定加压钢板符合寰椎形态学要求,可用于重建寰椎前弓完整性及恢复寰枢椎复合体高度,有效保留上颈椎结构功能。
BACKGROUND: There is a lack of plate for single-segment fixation through transoral approach to treat atlas fracture. OBJECTIVE: To develop a locking compression plate through transoral approach based on the clinical practice and anatomical data of atlas. METHODS: The anatomic parameters of atlas from 96 normal adults were measured with PACS system and CT image system, including width of anterior arch of atlas, height of anterior tubercle of atlas, length of the lateral mass, length of the atlas, middle height of the lateral mass, the extraversion angle of lateral mass of atlas(α), the radian(θ) of anterior arch of atlas, and inter membrane space. The data were statistically analyzed by SPSS 18.0 software in order to design the locking compression plate through transoral approach. RESULTS AND CONCLUSION:(1) The width of anterior arch of atlas was(8.85±1.47) mm, height of anterior tubercle of atlas was(12.49±2.28) mm, length of the lateral mass was(20.14±1.54) mm, length of the atlas was(39.68±2.29) mm, middle height of the lateral mass was(9.98±1.48) mm, the extraversion angle of lateral mass of atlas(α) was(13.92±1.90)°, the radian(θ) of anterior arch of atlas was(147.32±4.53)° and inter membrane space was(3.12±0.49) mm.(2) The locking compression plate through transoral approach was successfully designed, and obtained national patent.(3) To conclude, the locking compression plate through transoral approach meets the requirement of atlas morphology, not only rebuilds the stability of anterior arch of the atlas, but also restores the height of the atlas complex, and preserves the structure function of the upper atlas effectively.
BACKGROUND: There is a lack of plate for single-segment fixation through transoral approach to treat atlas fracture. OBJECTIVE: To develop a locking compression plate through transoral approach based on the clinical practice and anatomical data of atlas. METHODS: The anatomic parameters of atlas from 96 normal adults were measured with PACS system and CT image system, including width of anterior arch of atlas, height of anterior tubercle of atlas, length of the lateral mass, length of the atlas, middle height of the lateral mass, the extraversion angle of lateral mass of atlas(α), the radian(θ) of anterior arch of atlas, and inter membrane space. The data were statistically analyzed by SPSS 18.0 software in order to design the locking compression plate through transoral approach. RESULTS AND CONCLUSION:(1) The width of anterior arch of atlas was(8.85±1.47) mm, height of anterior tubercle of atlas was(12.49±2.28) mm, length of the lateral mass was(20.14±1.54) mm, length of the atlas was(39.68±2.29) mm, middle height of the lateral mass was(9.98±1.48) mm, the extraversion angle of lateral mass of atlas(α) was(13.92±1.90)°, the radian(θ) of anterior arch of atlas was(147.32±4.53)° and inter membrane space was(3.12±0.49) mm.(2) The locking compression plate through transoral approach was successfully designed, and obtained national patent.(3) To conclude, the locking compression plate through transoral approach meets the requirement of atlas morphology, not only rebuilds the stability of anterior arch of the atlas, but also restores the height of the atlas complex, and preserves the structure function of the upper atlas effectively.
引文
[1]Moore B,Parker C.3D morphometry of the transverse and alar ligaments in the occipito-atlanto-axial complex:An in vitro analysis.Clin Anat.2007;20(8):892-898.
[2]赖育鹏,贺伦,黄玮轩,等.人体寰椎解剖学观测[J].中国临床解剖学杂志,2016,33(4):159-160.
[3]Laurence A,Olivier DW,Michel W,et al.Posterior osteosynth esis of the atlas for nonconsolidated Jefferson fractures:a new surgical technique.Spine.2011;36(20):1360-1363.
[4]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures.Spine.2004;29(7):823-827.
[5]Jo KW,Park IS,Hong JT.Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct.J Clin Neurosci.2011;18(5):695-698.
[6]黄帅,王文涛,沈禹航,等.寰椎椎弓根螺钉导向器的研制及初步应用[J].第二军医大学学报,2016,9(37):1139-1143.
[7]董春科,李配瑶,谭明,等.后路辅助寰椎椎弓根螺钉置钉技术的研究进展[J].中国矫形外科杂志,2016,24(10):1884-1887.
[8]孙德志,倪斌,杨军,等.后路寰椎侧块螺钉联合枢椎椎板钩内固定的生物力学稳定性[J].脊柱外科杂志,2016,14(6):367-370.
[9]郭晓辉,刘兰泽,逯强,等.寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用[J].中国脊柱脊髓杂志,2015,2(12):1129-1131.
[10]王智运,尹庆水,艾福志,等.经口前路寰枢椎钢板内固定手术的应用解剖[J].中国临床解剖学杂志,2009,27(3):237-240.
[11]赵志新,王玮,米立国.寰椎应用解剖的研究进展[J].河北医科大学学报,2016,37(2):233-236.
[12]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function preserving option in the treatment of unstable Jefferson fractures.Spine.2004;29(7):823-827.
[13]Dickman CA,Greene KA,Sonntag VK.Injuries involving the transverse atlantal ligament:classification and treatment guidelines based upon experience with 39 injuries.Neurosurgery.1996;38(1):44-50.
[14]黄大耿,贺宝荣,郝定均,等.成人寰椎骨折的治疗策略[J].中国脊柱脊髓杂志,2017,27(5):399-406.
[15]赖育鹏,贺伦,黄玮轩,等.人体寰椎解剖学观测[J].中国临床解剖学杂志,2016,33(4):159-160.
[16]孙德志,倪斌,杨军,等.后路寰椎侧块螺钉联合枢椎椎板钩内固定的生物力学稳定性[J].脊柱外科杂志,2016,14(6):367-370.
[17]郭晓辉,刘兰泽,逯强,等.寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用[J].中国脊柱脊髓杂志,2015,2(12):1129-1131.
[18]王力冉,赵刘军,马维虎.经口咽入路单节段固定治疗不稳定性寰椎骨折的研究进展[J],中国骨伤,2017,30(1):93-96.
[19]Hu Y,Albert TJ,Kepler CK,et al.Unstable Jefferson fractures:results of transoral osteosynthesis.Indian J Orthop.2014;48(2):145-151.
[20]夏虹,尹庆水,林宏衡,等.Jefferson骨折复位钢板的设计、改良及初步临床应用[J].中华骨科杂志,2015,3(5):527-535.
[21]孙韶华,方剑利,马维虎,等.经口咽入路钢板内固定治疗不稳定性寰椎骨折[J].中国骨伤,2013,26(1):81-84.
[22]赵朵,农桔安,杨渊,等.经口咽微型钢板与后路钉板单节段内固定治疗不稳定型Jefferson骨折的疗效比较[J].中国骨与关节杂志,2018,7(6):407-412.
[23]李小峰,覃俊杰,李强,等.掌骨重建钢板模拟单节段固定修复寰椎骨折:体外三维运动生物力学分析[J].中国组织工程研究,2016,20(39):5819-5824.
[24]尹庆水,夏虹,吴增晖,等.经口入路复位内固定治疗不稳定性Jefferson骨折[J].中国骨科临床与基础研究杂志,2012,4(6):405-411
[25]胡勇,马维虎,顾勇杰,等.经口咽入路内固定治疗孤立性寰椎骨折临床疗效分析[J].脊柱外科杂志,2011,9(3):131-135.
[26]Kakarla UK,Chang SW,Theodore N,et al.Atlas fractures.Neurosurgery.2010;66(3 Suppl):60-67.
[27]韩应超,杨明杰,潘杰,等.单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析[J].中国脊柱脊髓杂志,2014,24(1):68-73.
[28]Koller H1,Resch H,Tauber M,et al.A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament.Eur Spine J.2010;19(8):1288-1298.
[29]Puttlitz CM,Goel VK,Clark CR,et al.Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction.Spine.2000;25:1607-1616.
[2]赖育鹏,贺伦,黄玮轩,等.人体寰椎解剖学观测[J].中国临床解剖学杂志,2016,33(4):159-160.
[3]Laurence A,Olivier DW,Michel W,et al.Posterior osteosynth esis of the atlas for nonconsolidated Jefferson fractures:a new surgical technique.Spine.2011;36(20):1360-1363.
[4]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures.Spine.2004;29(7):823-827.
[5]Jo KW,Park IS,Hong JT.Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct.J Clin Neurosci.2011;18(5):695-698.
[6]黄帅,王文涛,沈禹航,等.寰椎椎弓根螺钉导向器的研制及初步应用[J].第二军医大学学报,2016,9(37):1139-1143.
[7]董春科,李配瑶,谭明,等.后路辅助寰椎椎弓根螺钉置钉技术的研究进展[J].中国矫形外科杂志,2016,24(10):1884-1887.
[8]孙德志,倪斌,杨军,等.后路寰椎侧块螺钉联合枢椎椎板钩内固定的生物力学稳定性[J].脊柱外科杂志,2016,14(6):367-370.
[9]郭晓辉,刘兰泽,逯强,等.寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用[J].中国脊柱脊髓杂志,2015,2(12):1129-1131.
[10]王智运,尹庆水,艾福志,等.经口前路寰枢椎钢板内固定手术的应用解剖[J].中国临床解剖学杂志,2009,27(3):237-240.
[11]赵志新,王玮,米立国.寰椎应用解剖的研究进展[J].河北医科大学学报,2016,37(2):233-236.
[12]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function preserving option in the treatment of unstable Jefferson fractures.Spine.2004;29(7):823-827.
[13]Dickman CA,Greene KA,Sonntag VK.Injuries involving the transverse atlantal ligament:classification and treatment guidelines based upon experience with 39 injuries.Neurosurgery.1996;38(1):44-50.
[14]黄大耿,贺宝荣,郝定均,等.成人寰椎骨折的治疗策略[J].中国脊柱脊髓杂志,2017,27(5):399-406.
[15]赖育鹏,贺伦,黄玮轩,等.人体寰椎解剖学观测[J].中国临床解剖学杂志,2016,33(4):159-160.
[16]孙德志,倪斌,杨军,等.后路寰椎侧块螺钉联合枢椎椎板钩内固定的生物力学稳定性[J].脊柱外科杂志,2016,14(6):367-370.
[17]郭晓辉,刘兰泽,逯强,等.寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用[J].中国脊柱脊髓杂志,2015,2(12):1129-1131.
[18]王力冉,赵刘军,马维虎.经口咽入路单节段固定治疗不稳定性寰椎骨折的研究进展[J],中国骨伤,2017,30(1):93-96.
[19]Hu Y,Albert TJ,Kepler CK,et al.Unstable Jefferson fractures:results of transoral osteosynthesis.Indian J Orthop.2014;48(2):145-151.
[20]夏虹,尹庆水,林宏衡,等.Jefferson骨折复位钢板的设计、改良及初步临床应用[J].中华骨科杂志,2015,3(5):527-535.
[21]孙韶华,方剑利,马维虎,等.经口咽入路钢板内固定治疗不稳定性寰椎骨折[J].中国骨伤,2013,26(1):81-84.
[22]赵朵,农桔安,杨渊,等.经口咽微型钢板与后路钉板单节段内固定治疗不稳定型Jefferson骨折的疗效比较[J].中国骨与关节杂志,2018,7(6):407-412.
[23]李小峰,覃俊杰,李强,等.掌骨重建钢板模拟单节段固定修复寰椎骨折:体外三维运动生物力学分析[J].中国组织工程研究,2016,20(39):5819-5824.
[24]尹庆水,夏虹,吴增晖,等.经口入路复位内固定治疗不稳定性Jefferson骨折[J].中国骨科临床与基础研究杂志,2012,4(6):405-411
[25]胡勇,马维虎,顾勇杰,等.经口咽入路内固定治疗孤立性寰椎骨折临床疗效分析[J].脊柱外科杂志,2011,9(3):131-135.
[26]Kakarla UK,Chang SW,Theodore N,et al.Atlas fractures.Neurosurgery.2010;66(3 Suppl):60-67.
[27]韩应超,杨明杰,潘杰,等.单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析[J].中国脊柱脊髓杂志,2014,24(1):68-73.
[28]Koller H1,Resch H,Tauber M,et al.A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament.Eur Spine J.2010;19(8):1288-1298.
[29]Puttlitz CM,Goel VK,Clark CR,et al.Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction.Spine.2000;25:1607-1616.