前路经枕寰枢关节锁定钛板螺钉内固定的解剖学研究
发布时间：2018-09-07 17:43
【摘要】：枕寰枢复合体位于生命中枢相对应的部位,具有独特及复杂的解剖结构和功能。各种先天性或获得性因素致其局部骨质和韧带结构破坏所引起的枕颈部不稳,易导致延髓、高位脊髓压迫,潜在危险性大,往往需行枕颈融合内固定术。由于寰、枢椎及枕骨髁处于颅颈连接区域,解剖位置深、结构复杂,与延髓、脊髓、椎动脉、咽喉、气管、食管、颈部大血管及喉上神经、舌下神经等重要结构关系紧密,被视为外科手术的危险区域。后路手术以其显露容易、易于安置内固定器械而受到临床推崇。但对于临床上后路手术实施困难或无法实施的病例,前路手术成为一种相对理想的选择。目前,前路经枕寰枢关节螺钉内固定已有个案报道,但因单用螺钉固定力学性能不高,进钉方向不易把握且对枢椎椎体前侧骨性结构要求高,临床上未能普及。有鉴于此,我科自行研制了一套前路经枕寰枢关节锁定钛板螺钉系统。 本研究通过对前路经关节解剖锁定钢板螺钉内固定术进行相关的临床解剖学研究,设计出适合国人的锁定解剖钛板及其安装器械系列。锁定解剖钛板用于颌下手术入路,其兼有锁定与瞄准器功能,可简化手术操作,增强内固定的稳定性。通过对其相关的基础研究,评估其临床应用的可行性及安全性,将为治疗创伤性枕颈部不稳定患者提供一种具有自主知识产权的新型内固定技术与器械,可提高枕颈不稳定患者的救治成功率,减轻病人的痛苦及社会负担,具有极大的军事及社会效益。 研究目的 1、通过测量前路经枕寰枢关节锁定钛板螺钉内固定术的相关解剖学参数,评估国人前路经枕寰枢关节锁定钛板螺钉内固定术的可行性,为其临床应用提供解剖学依据； 2、通过测量前路经枕寰枢关节锁定钛板螺钉内固定术的钉道参数及钉道与椎动脉的距离,评估前路经枕寰枢关节锁定钛板螺钉内固定术的安全性； 3、通过对前路经枕寰枢关节锁定钛板螺钉内固定术的相关解剖学参数进行测量,为此种内固定系统的设计提供解剖学依据；4、通过模拟内固定手术,验证前路经寰枢关节螺钉内固定术内固定螺钉的可行性与安全性,为其临床应用提供实验依据。 实验一干燥枕寰枢配套标本的解剖学测量 目的通过测量国人前路经枕寰枢关节锁定钛板螺钉内固定术的相关解剖学参数,评估前路经枕寰枢关节锁定钛板螺钉内固定术的可行性,为其临床应用提供解剖学依据。 方法取30具国人干燥枕颈部标本,观察枕寰枢骨性结构的解剖学形态特点；测量与前路经枕寰枢关节锁定钛板螺钉内固定术相关的解剖径线：枕骨髁关节面前后径及左右径,舌下神经管与枕骨髁关节面间距,枕骨髁后缘1/3高度,寰椎上关节面前后径与左右径,寰椎侧块内缘及外缘高度,枢椎上关节面前后径与左右径,枢椎椎体左右径与上下径；经关节螺钉钉道参数：螺钉植入最大外倾角,最小外倾角,理想外倾角,最大后倾角,理想后倾角,内侧钉道长度,外侧钉道长度,理想钉道长度；椎体固定螺钉钉道参数：螺钉植入理想内倾角,理想上倾角,理想钉道长度。 结果枕寰枢骨性结构的解剖学形态特点:(1)枢椎前弓下缘与枢椎椎体侧缘交界点上方约4mm有一恒定存在的骨性凹陷,骨性标志明确；(2)舌下神经管是位于枕骨髁关节面上方的骨性管道,管道自内后向前外上方走行。舌下神经管位于枕骨髁前2/3者51例(85%),枕骨髁后1/3者9例(15%)；(3)寰椎侧块外厚内薄,其外缘高度约为内缘高度的2倍；其上关节面呈肾形凹面,中部狭窄,下关节面内缘较上关节面内缘更靠近矢状面；(4)枕骨髁关节面呈舟状凸面,中部较前后缘厚,其中1例枕骨髁呈哑铃状(1.67%)；同时大部分标本枕髁后方有一髁窝,出现率为47例(78.33%)；(5)枢椎椎体前表面中部为一“鼻状”突起；(6)枢椎椎体前下缘形成“舌状”突出,使椎体下表面呈“穹窿状”。前路经枕寰枢关节锁定钛板螺钉内固定术相关的解剖径线及钉道参数：经关节螺钉入钉点间距(15.25±0.94)mm；在矢状面上螺钉植入的最小外倾角为(10.23±0.63)°,最大外倾角为(27.73±2.67)°,理想外倾角为(18.75±1.70)°；冠状面上最大后倾角为(31.72±2.59)°,理想后倾角(24.40±2.11)°；内、外侧钉道长度分别为(32.98±1.68)mm、(36.54±2.01)mm；理想钉道长度(34.45±1.95)mm。 结论前路经枕寰枢关节锁定钛板螺钉内固定术在解剖上是可行的。 实验二前路经枕寰枢关节锁定钛板螺钉内固定的CTA测量及其临床意义 目的：通过对头颈部CTA检查的影像资料行前路经枕寰枢关节锁定钛板螺钉内固定术的相关钉道参数及钉道与椎动脉的距离进行测量,评估此种内固定术的安全性。 研究对象：从我院头颈部CTA检查的影像资料中随机选取30例,其中男18例,女12例；年龄21～55岁,平均33.6±4.2岁。纳入标准：①年龄20-60岁；②检查时间为从2010年10月01至2011年04月01日。排除标准：①发育畸形及解剖变异；②骨质破坏(含肿瘤、炎症或骨折等)；③既往颈椎病病史；④既往颈椎手术史。 方法：将纳入本研究的30例CTA检查原始扫描数据传入Vitreal4.0工作站,通过容积显示(VR)、多平面重建(MPR)等技术进行图像处理。在重建图像上观察枕寰枢骨性结构及钉道平面椎动脉的形态特点。观察枢椎椎体前表面的解剖学特征,寻求螺钉入钉点解剖标志；观察舌下神经管与枕骨髁的相对位置,确定螺钉安全的锚定点；观察上颈椎椎动脉的走行特点;利用Vitreal软件测量经关节螺钉理想钉道角度与长度和椎体固定螺钉钉道角度与长度。测量入钉点平面两侧椎动脉间距及不同层面上钉道与椎动脉的距离。 结果：椎动脉于入钉点平面至锚定点平面在形态上有5个恒定的弯曲,其中第1、3弯曲处椎动脉更加靠近正中矢状面,经关节螺钉入钉点平面处两侧椎动脉间距为(25.59±1.04)mm。经关节螺钉钉道参数：入钉点间距(15.25±0.94)mm,理想外倾角(18.75±1.70)mm,理想后倾角(24.40±2.11)mm。椎体固定螺钉钉道参数：入钉点间距(9.21±0.72)mm,理想内倾角(13.89±0.87)mm,理想上倾角(17.21±1.14)mm。经关节螺钉理想钉道与椎动脉的关系于寰椎横突孔上方椎动脉弯曲平面最为密切,其距离为(3.6±0.71)mm。 结论：国人采用前路经枕寰枢关节锁定钛板螺钉内固定在解剖上是可行的,钉道与椎动脉之间有一定的安全距离,但术中必须严格控制钉道方向。术前通过螺旋CTA三维重建片进行个体化术前设计,可以模拟前路经枕寰枢关节锁定钛板螺钉内固定的钉道轨迹、钉道的理想角度和长度,有效地避免钉道对椎动脉的损伤,有助于提高患者的安全性。 实验三模拟前路经枕寰枢关节螺钉内固定术的实验研究 目的：通过模拟前路经枕寰枢关节螺钉内固定术,探讨前路经枕寰枢关节螺钉内固定的可行性与安全性,为其临床应用提供实验依据。 方法：对国人枕颈部干燥配套标本及福尔马林常规防腐标本行CT三维重建检查,并进行个体化术前设计。依据术前测量的个体化参数在标本上模拟前路经枕寰枢关节螺钉内固定术。首先显露骨性标志,确定入钉点,选择枕骨髁长轴的中后1/3为理想锚定点,分别应用1.0mm克氏针按术前测量的理想钉道角度在外置导向器辅助下向外、后、上方钻入,边进针边透视,整个操作过程在C臂X光机透视监测下进行,透视见克氏针方向、长度满意后用2.7mm空心电钻沿克氏针钻入,依次穿过寰枢关节及寰枕关节进入枕骨髁,至枕骨髁上方皮质下停止。测深并选择合适长度的4.0mmAO钛质空心螺钉拧入。标本固定后行X线及CT检查以验证螺钉位置,运用计算机软件测量实际钉道的角度、长度。 结果：枕颈部标本模拟前路经枕寰枢关节螺钉内固定术后可获得即刻稳定,术后影像学检查证实螺钉经过寰枕关节及寰枢关节,均位于骨性结构内,无穿出骨质者；螺钉均未损伤舌下神经管。利用CT白带的Vitreal计算机软件测量实际钉道参数(外倾角、后倾角、长度)均位于其参考值的范围之内。 结论：国人采用前路经枕寰枢关节螺钉内固定在解剖上是可行的。但应注意其对钉道的准确性要求较高,临床上为增加手术的安全性,恢复患者枕颈部结构的正常解剖关系是应用此种内固定术的前提。
[Abstract]:Occipito-atlanto-occipital complex has unique and complex anatomical structures and functions in the corresponding parts of the life center. Occipito-cervical instability caused by various congenital or acquired factors may easily lead to the medulla oblongata, compression of the high spinal cord, and potentially dangerous. Occipito-cervical fusion and internal fixation are often required. The atlas, axis and occipital condyle are located in the craniocervical junction area, with deep anatomical position and complex structure. They are closely related to the medulla oblongata, spinal cord, vertebral artery, pharynx, larynx, trachea, esophagus, cervical blood vessels, superior laryngeal nerve, hypoglossal nerve and other important structures, and are considered as dangerous areas for surgical operations. Posterior approach surgery is easy to expose and easy to place internal fixation instruments. Anterior transoccipito-atlantoaxial screw fixation has been reported in some cases, but because of its poor mechanical properties, the direction of screw insertion is difficult to grasp and the anterior osseous structure of the axial vertebral body is important. In view of this, our department has developed a set of anterior transoccipito-atlantoaxial locking titanium plate screw system.
In this study, we designed a series of locking anatomical titanium plates and their installing instruments suitable for Chinese through clinical anatomical study of anterior transarticular locking plate and screw fixation. Locked anatomical titanium plates are used for submandibular surgery, which have the function of locking and sighting devices. They can simplify the operation and enhance the stability of internal fixation. To evaluate the feasibility and safety of its clinical application through the relevant basic research will provide a new type of internal fixation technology and equipment with independent intellectual property rights for the treatment of traumatic occipitocervical instability, which can improve the success rate of treatment of patients with occipitocervical instability, alleviate the pain and social burden of patients with great. Military and social benefits.
research objective
1. To evaluate the feasibility of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipital atlantoaxial locking titanium plate screw fixation, and to provide anatomical basis for its clinical application.
2. To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation, the parameters of screw path and the distance between screw path and vertebral artery were measured.
3. To provide anatomical basis for the design of the anterior transatlantoaxial locking titanium plate screw fixation system by measuring the related anatomical parameters; 4. To verify the feasibility and safety of the anterior transatlantoaxial screw fixation by simulating the operation. Experimental basis.
Anatomic measurement of dried occipital atlantoaxial matching specimens
Objective To evaluate the feasibility of anterior transoccipito-atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipito-atlantoaxial locking titanium plate screw fixation.
Methods 30 dry occipital and cervical specimens of Chinese were taken to observe the anatomical features of occipital and atlantoaxial bony structures, and the anatomical diameters related to anterior transoccipital atlantoaxial locking titanium plate screw fixation were measured: the anterior and posterior diameters of occipital condylar joint, the distance between hypoglossal nerve canal and occipital condylar joint, the height of occipital condyle posterior margin 1/3, the height of atlas. Anterior and posterior diameters and left and right diameters of the upper joints, height of the inner and outer edges of the lateral mass of the atlas, anterior and posterior diameters and left and right diameters of the upper joints, left and right diameters and upper and lower diameters of the axis; parameters of the trans-articular screw path: maximum extroversion angle, minimum extroversion angle, ideal extroversion angle, maximum posteversion angle, ideal posterior inclination angle, medial screw path length, lateral screw path Length, ideal screw path length; Vertebral fixation screw path parameters: ideal inclination angle, ideal inclination angle, ideal screw path length.
Results The anatomical and morphological characteristics of occipito-atlantoaxial bony structure were as follows: (1) There was a constant osseous depression about 4 mm above the junction of anterior arc of axis and lateral margin of axis, and the osseous markers were clear; (2) The hypoglossal canal was a osseous canal located above the occipital condyle joint, and the canal ran from inside to outside. 51 cases (85%) had anterior 2/3 of the condyle, 9 cases (15%) had posterior 1/3 of the occipital condyle; (3) the lateral mass of the atlas was thick and thin, and the height of its outer edge was about twice the height of the inner edge; the upper joint surface was kidney-shaped concave, the middle was narrow, and the inner edge of the inferior joint surface was closer to the sagittal surface than the inner edge of the upper joint surface; (4) the occipital condyle surface was scaphoid, and the middle was thicker than the anterior and posterior edge, of which 1. The occipital condyle was dumbbell-shaped (1.67%) in most cases, and there was a condylar fossa behind the occipital condyle in 47 cases (78.33%); (5) the middle part of the anterior surface of the axis was a "nose-like" protrusion; (6) the anterior and inferior edge of the axis formed a "tongue-like" protrusion, which made the subsurface of the vertebral body "fornix-like". Anterior fixation with titanium plate screw locked through the occipito-atlanto-axial joint. The anatomical diameter and the parameters of the screw canal were as follows: the distance between the insertion points was (15.25 (+ 0.94) mm; the minimum extroversion angle was (10.23 (+) 0.63)degrees, the maximum extroversion angle was (27.73 (+) 2.67)degrees, the ideal extroversion angle was (18.75 (+) 1.70)degrees; the maximum retroversion angle was (31.72 (+) 2.59)degrees and the ideal retroversion angle was (24.40 (+) 2.1). The length of internal and external nail canals were (32.98 (+ 1.68) mm, (36.54 (+ 2.01) mm, and the ideal nail canal length was (34.45 (+ 1.95) mm.
Conclusion anterior locking titanium plate fixation via occipital atlantoaxial joint is feasible in anatomy.
Experiment two CTA measurement of anterior atlantoaxial locking titanium plate fixation and its clinical significance
Objective: To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the parameters of screw path and the distance between screw path and vertebral artery.
Participants: Thirty patients, 18 males and 12 females, aged 21-55 years with an average of 33.6 (+ 4.2 years) were randomly selected from the CT images of head and neck in our hospital. A history of cervical spondylosis; a history of previous cervical surgery.
Methods: The original CT scan data of 30 cases were transferred to Vitreal 4.0 workstation and processed by volume rendering (VR) and multiplanar reconstruction (MPR). Anatomical markers of screw insertion points; relative positions of hypoglossal canal and occipital condyle were observed to determine the safe anchoring point of screw; the course characteristics of superior cervical vertebral artery were observed; the ideal angle and length of screw path and the angle and length of screw path were measured by Vitreal software; and the intervertebral arteries were measured on both sides of the plane of screw insertion points. The distance between nail path and vertebral artery at different levels.
Results: There were five constant curvatures of vertebral artery from the plane of screw entry point to the plane of anchorage point. The first and third curvatures of vertebral artery were closer to the median sagittal plane. The interval between vertebral artery and vertebral artery at the plane of screw entry point was (25.59 (1.04) mm. The ideal posterior inclination angle was (24.40 (+ 2.11) m M. The parameters of the screw canal were (9.21 (+ 0.72) m m at the entry point, 13.89 (+ 0.87) m m at the ideal inclination angle, 17.21 (+ 1.14) m M. The relationship between the ideal screw canal and the vertebral artery was the closest at the curvature plane of the vertebral artery above the transverse foramen of the atlas, and the distance was (3.6 (+ 0.71) M. M.
Conclusion: Anterior transoccipito-atlantoaxial locking titanium plate screw fixation is anatomically feasible in Chinese. There is a safe distance between the screw canal and vertebral artery, but the direction of the screw canal must be strictly controlled during operation. The trajectory of the screw path, the ideal angle and length of the screw path can effectively avoid the injury of the vertebral artery and improve the safety of the patients.
Experiment three experimental study of anterior atlantoaxial screw fixation via simulated anterior approach
Objective: To investigate the feasibility and safety of anterior transoccipital atlantoaxial screw fixation by simulating anterior transoccipital atlantoaxial screw fixation, and to provide experimental basis for its clinical application.
Methods: Three-dimensional CT reconstructions were performed on Chinese dry occipitocervical specimens and formalin preserved specimens, and individualized preoperative design was carried out. The latter 1/3 is the ideal anchoring point, respectively, using 1.0 mm Kirschner wire according to the preoperative measurement of the ideal angle of the nail path outside under the assistance of external guide, after drilling in the upper part, while the needle fluoroscopy, the entire operation process under the C-arm X-ray machine perspective monitoring, fluoroscopy Kirschner needle direction, the length of satisfaction with the 2.7 mm hollow electric drill along the Kirschner needle drilling, in turn through. Transatlanto-axial and atlanto-occipital joints entered the occipital condyle and stopped below the cortex above the occipital condyle. The appropriate length of 4.0 mm AO titanium hollow screw was selected and screwed in. The specimens were fixed and examined by X-ray and CT to verify the screw position. The angle and length of the actual screw canal were measured by computer software.
Results: The occipitocervical specimens were stabilized immediately after simulated anterior transoccipito-atlantoaxial screw fixation. Imaging examination showed that the screw was located in the osseous structure and did not penetrate the osseous structure. The hypoglossal nerve canal was not damaged by the screw. The path parameters (camber, dip angle and length) are all within the scope of their reference values.
Conclusion: Anterior trans-occipito-atlantoaxial screw fixation is anatomically feasible in Chinese, but the accuracy of the screw canal should be paid attention to. In order to increase the safety of the operation, restoring the normal anatomical relationship of the occipito-cervical structure is the premise of this kind of internal fixation.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322.7;R687.4
本文编号：2228965
[Abstract]:Occipito-atlanto-occipital complex has unique and complex anatomical structures and functions in the corresponding parts of the life center. Occipito-cervical instability caused by various congenital or acquired factors may easily lead to the medulla oblongata, compression of the high spinal cord, and potentially dangerous. Occipito-cervical fusion and internal fixation are often required. The atlas, axis and occipital condyle are located in the craniocervical junction area, with deep anatomical position and complex structure. They are closely related to the medulla oblongata, spinal cord, vertebral artery, pharynx, larynx, trachea, esophagus, cervical blood vessels, superior laryngeal nerve, hypoglossal nerve and other important structures, and are considered as dangerous areas for surgical operations. Posterior approach surgery is easy to expose and easy to place internal fixation instruments. Anterior transoccipito-atlantoaxial screw fixation has been reported in some cases, but because of its poor mechanical properties, the direction of screw insertion is difficult to grasp and the anterior osseous structure of the axial vertebral body is important. In view of this, our department has developed a set of anterior transoccipito-atlantoaxial locking titanium plate screw system.
In this study, we designed a series of locking anatomical titanium plates and their installing instruments suitable for Chinese through clinical anatomical study of anterior transarticular locking plate and screw fixation. Locked anatomical titanium plates are used for submandibular surgery, which have the function of locking and sighting devices. They can simplify the operation and enhance the stability of internal fixation. To evaluate the feasibility and safety of its clinical application through the relevant basic research will provide a new type of internal fixation technology and equipment with independent intellectual property rights for the treatment of traumatic occipitocervical instability, which can improve the success rate of treatment of patients with occipitocervical instability, alleviate the pain and social burden of patients with great. Military and social benefits.
research objective
1. To evaluate the feasibility of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipital atlantoaxial locking titanium plate screw fixation, and to provide anatomical basis for its clinical application.
2. To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation, the parameters of screw path and the distance between screw path and vertebral artery were measured.
3. To provide anatomical basis for the design of the anterior transatlantoaxial locking titanium plate screw fixation system by measuring the related anatomical parameters; 4. To verify the feasibility and safety of the anterior transatlantoaxial screw fixation by simulating the operation. Experimental basis.
Anatomic measurement of dried occipital atlantoaxial matching specimens
Objective To evaluate the feasibility of anterior transoccipito-atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipito-atlantoaxial locking titanium plate screw fixation.
Methods 30 dry occipital and cervical specimens of Chinese were taken to observe the anatomical features of occipital and atlantoaxial bony structures, and the anatomical diameters related to anterior transoccipital atlantoaxial locking titanium plate screw fixation were measured: the anterior and posterior diameters of occipital condylar joint, the distance between hypoglossal nerve canal and occipital condylar joint, the height of occipital condyle posterior margin 1/3, the height of atlas. Anterior and posterior diameters and left and right diameters of the upper joints, height of the inner and outer edges of the lateral mass of the atlas, anterior and posterior diameters and left and right diameters of the upper joints, left and right diameters and upper and lower diameters of the axis; parameters of the trans-articular screw path: maximum extroversion angle, minimum extroversion angle, ideal extroversion angle, maximum posteversion angle, ideal posterior inclination angle, medial screw path length, lateral screw path Length, ideal screw path length; Vertebral fixation screw path parameters: ideal inclination angle, ideal inclination angle, ideal screw path length.
Results The anatomical and morphological characteristics of occipito-atlantoaxial bony structure were as follows: (1) There was a constant osseous depression about 4 mm above the junction of anterior arc of axis and lateral margin of axis, and the osseous markers were clear; (2) The hypoglossal canal was a osseous canal located above the occipital condyle joint, and the canal ran from inside to outside. 51 cases (85%) had anterior 2/3 of the condyle, 9 cases (15%) had posterior 1/3 of the occipital condyle; (3) the lateral mass of the atlas was thick and thin, and the height of its outer edge was about twice the height of the inner edge; the upper joint surface was kidney-shaped concave, the middle was narrow, and the inner edge of the inferior joint surface was closer to the sagittal surface than the inner edge of the upper joint surface; (4) the occipital condyle surface was scaphoid, and the middle was thicker than the anterior and posterior edge, of which 1. The occipital condyle was dumbbell-shaped (1.67%) in most cases, and there was a condylar fossa behind the occipital condyle in 47 cases (78.33%); (5) the middle part of the anterior surface of the axis was a "nose-like" protrusion; (6) the anterior and inferior edge of the axis formed a "tongue-like" protrusion, which made the subsurface of the vertebral body "fornix-like". Anterior fixation with titanium plate screw locked through the occipito-atlanto-axial joint. The anatomical diameter and the parameters of the screw canal were as follows: the distance between the insertion points was (15.25 (+ 0.94) mm; the minimum extroversion angle was (10.23 (+) 0.63)degrees, the maximum extroversion angle was (27.73 (+) 2.67)degrees, the ideal extroversion angle was (18.75 (+) 1.70)degrees; the maximum retroversion angle was (31.72 (+) 2.59)degrees and the ideal retroversion angle was (24.40 (+) 2.1). The length of internal and external nail canals were (32.98 (+ 1.68) mm, (36.54 (+ 2.01) mm, and the ideal nail canal length was (34.45 (+ 1.95) mm.
Conclusion anterior locking titanium plate fixation via occipital atlantoaxial joint is feasible in anatomy.
Experiment two CTA measurement of anterior atlantoaxial locking titanium plate fixation and its clinical significance
Objective: To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the parameters of screw path and the distance between screw path and vertebral artery.
Participants: Thirty patients, 18 males and 12 females, aged 21-55 years with an average of 33.6 (+ 4.2 years) were randomly selected from the CT images of head and neck in our hospital. A history of cervical spondylosis; a history of previous cervical surgery.
Methods: The original CT scan data of 30 cases were transferred to Vitreal 4.0 workstation and processed by volume rendering (VR) and multiplanar reconstruction (MPR). Anatomical markers of screw insertion points; relative positions of hypoglossal canal and occipital condyle were observed to determine the safe anchoring point of screw; the course characteristics of superior cervical vertebral artery were observed; the ideal angle and length of screw path and the angle and length of screw path were measured by Vitreal software; and the intervertebral arteries were measured on both sides of the plane of screw insertion points. The distance between nail path and vertebral artery at different levels.
Results: There were five constant curvatures of vertebral artery from the plane of screw entry point to the plane of anchorage point. The first and third curvatures of vertebral artery were closer to the median sagittal plane. The interval between vertebral artery and vertebral artery at the plane of screw entry point was (25.59 (1.04) mm. The ideal posterior inclination angle was (24.40 (+ 2.11) m M. The parameters of the screw canal were (9.21 (+ 0.72) m m at the entry point, 13.89 (+ 0.87) m m at the ideal inclination angle, 17.21 (+ 1.14) m M. The relationship between the ideal screw canal and the vertebral artery was the closest at the curvature plane of the vertebral artery above the transverse foramen of the atlas, and the distance was (3.6 (+ 0.71) M. M.
Conclusion: Anterior transoccipito-atlantoaxial locking titanium plate screw fixation is anatomically feasible in Chinese. There is a safe distance between the screw canal and vertebral artery, but the direction of the screw canal must be strictly controlled during operation. The trajectory of the screw path, the ideal angle and length of the screw path can effectively avoid the injury of the vertebral artery and improve the safety of the patients.
Experiment three experimental study of anterior atlantoaxial screw fixation via simulated anterior approach
Objective: To investigate the feasibility and safety of anterior transoccipital atlantoaxial screw fixation by simulating anterior transoccipital atlantoaxial screw fixation, and to provide experimental basis for its clinical application.
Methods: Three-dimensional CT reconstructions were performed on Chinese dry occipitocervical specimens and formalin preserved specimens, and individualized preoperative design was carried out. The latter 1/3 is the ideal anchoring point, respectively, using 1.0 mm Kirschner wire according to the preoperative measurement of the ideal angle of the nail path outside under the assistance of external guide, after drilling in the upper part, while the needle fluoroscopy, the entire operation process under the C-arm X-ray machine perspective monitoring, fluoroscopy Kirschner needle direction, the length of satisfaction with the 2.7 mm hollow electric drill along the Kirschner needle drilling, in turn through. Transatlanto-axial and atlanto-occipital joints entered the occipital condyle and stopped below the cortex above the occipital condyle. The appropriate length of 4.0 mm AO titanium hollow screw was selected and screwed in. The specimens were fixed and examined by X-ray and CT to verify the screw position. The angle and length of the actual screw canal were measured by computer software.
Results: The occipitocervical specimens were stabilized immediately after simulated anterior transoccipito-atlantoaxial screw fixation. Imaging examination showed that the screw was located in the osseous structure and did not penetrate the osseous structure. The hypoglossal nerve canal was not damaged by the screw. The path parameters (camber, dip angle and length) are all within the scope of their reference values.
Conclusion: Anterior trans-occipito-atlantoaxial screw fixation is anatomically feasible in Chinese, but the accuracy of the screw canal should be paid attention to. In order to increase the safety of the operation, restoring the normal anatomical relationship of the occipito-cervical structure is the premise of this kind of internal fixation.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322.7;R687.4
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