经口咽前路颅颈交界腹侧区显露与固定的解剖和临床研究

发布时间：2018-06-10 16:21

本文选题：经口咽前路 + 颅颈交界区　；参考：《第一军医大学》2005年硕士论文

【摘要】：背景寰枢椎的畸形、损伤、炎症和肿瘤均可使正常的解剖结构出现异常,失去稳定性,造成寰枢椎脱位,出现急性脊髓损伤,危及生命,也可以渐进性发展成为慢性高位颈脊髓病,往往需要进行外科治疗。以往寰枢椎不稳的固定方法均为进行后路手术。但是后入路手术无法解决难复性寰枢椎脱位伴脊髓压迫的患者的复位问题,对于此类患者,目前常规的治疗方法是先行经口前路齿突切除及瘢痕松解,然后再从仰卧体位变为俯卧位行后路固定,而在此过程中有可能会因脊柱的低稳定性造成对脊髓致命的损伤。我科尹庆水主任设计、研制并开发成功了寰枢椎即时复位钢板系统(transoralphatyngeal atlantoaxial reduction plate, TARP),在经口前路显露下进行松解、减压后,用特制的器械将脱位的寰椎进行复位,恢复正常的寰枢解剖关系,创造性的将前路减压、复位和寰枢融合固定一次性完成,避免了因翻身过程造成对脊髓的损伤和后路手术的创伤,在该领域取得重大突破。然而,目前关于寰枢椎经口钢板和C1、C2前方结构应用解剖方面鲜有报道。该项研究旨在给寰枢椎即时复位钢板系统手术提供解剖依据,起到使显露更为有效,复位更顺利,避免血管神经的损伤,缩短手术时间的作用。颅颈交界区(craniovertebral junction,CVJ)包括斜坡、枕骨大孔、寰椎和枢椎,毗邻上呼吸消化道、脑干、多对脑神经、颈内动脉、椎基底动脉等重要
[Abstract]:Background Atlantoaxial malformations, injuries, inflammation and tumors can make normal anatomical structure abnormal, lose stability, cause atlantoaxial dislocation, acute spinal cord injury and life-threatening. It can also develop progressively into chronic high cervical myelopathy, often requiring surgical treatment. The previous fixation of atlantoaxial instability was performed by posterior approach. However, posterior approach cannot solve the problem of reduction in patients with intractable atlantoaxial dislocation with spinal cord compression. Then the supine position is changed to the prone position with posterior fixation, which may result in fatal spinal cord injury due to the low stability of the spine. Director Yin Qingshui of our department designed, developed and developed the atlantoaxial immediate reduction plate system, transormal phatyngeal atlantoaxial reduction plate, Tarp, which was released through the anterior approach of the mouth. After decompression, the dislocated atlas was reduced with a specially made instrument. Restoration of normal atlantoaxial anatomical relationship, creative anterior decompression, reduction and atlantoaxial fusion fixation can avoid the injury of spinal cord caused by the process of turning over, and make a great breakthrough in this field. However, there are few reports on applied anatomy of atlantoaxial transoral plate and C _ 1 C _ 2 anterior structure. The aim of this study is to provide anatomical evidence for the immediate reduction of the atlantoaxial plate system, so as to make the exposure more effective, the reduction more smooth, and to avoid the injury of the blood vessels and nerves. Craniovertebral junction (CVJ) includes Clivus, foramen magnum, atlas and axis, adjacent upper respiratory tract, brain stem, cranial nerve, internal carotid artery, vertebrobasilar artery, etc.
【学位授予单位】：第一军医大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R687;R322

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