前路经寰枢关节解剖锁定钛板螺钉内固定系统的匹配性研究

目的通过模拟手术,观察新型前路经寰枢关节解剖锁定钛板螺钉内固定系统与寰枢椎复合体的匹配性,验证此内固定系统临床应用的可行性。方法对30具福尔马林浸泡的正常国人枕颈部标本模拟前路经寰枢关节解剖锁定钛板螺钉内固定术,术毕行计算机断层扫描(computed tomography,CT)、多平面重建(multi-planar reconstruction,MPR)及数字化X线摄影术(digital radiography,DR)。通过观察钛板位置,测量螺钉轨迹参数,不同平面上经寰枢关节螺钉与椎动脉及脊髓的距离、钉尖距寰椎侧块上关节面的距离,分析此内固定系统与寰枢椎复合体的匹配性。结果钛板与枢椎表面匹配,未超出枢椎体边缘,所有螺钉均在骨质内,无椎动脉、脊髓及寰枕关节损伤;经寰枢关节螺钉钉道冠状面上外偏角为(23.22±1.71)°,矢状面后倾角为(27.96±3.05)°,钉道长度为(27.50±1.55)mm,枢椎体螺钉横截面上内偏角为(9.55±0.80)°;矢状面上倾角为(25.35±2.36)°,钉道长度为(15.47±0.89)mm;在横截面A(寰椎横突孔上缘)经寰枢关节螺钉距椎动脉和脊髓最近,分别为(5.05±1.04)mm和(8.05±0.92)mm,与寰椎侧块上关节面距离为(3.15±0.67)mm。结论采用前路经寰枢关节解剖锁定钛板螺钉内固定系统,行寰枢椎固定具有临床可行性。

Match Assessment of Anterior Atlantoaxial Transarticular Anatomic Locking Titanium Plate Screw Fixiation System

Objective To testify the clinical feasibility of a new anterior atlantoaxial transarticular anatomic locking titanium plate screw fixiation system is testified by surgical model and match assessment.Methods The surgical models of anterior atlantoaxial transarticular anatomic locking titanium plate screw fixiation were manufactured on the 30 sets of normal Chinese adults craniovertebral junction specimens soaked in formalin,then the correlated screw trajectory parameters and the distance between atlantoaxial transarticular screw and vertebral artery、spinal cord in different planes,the upper articular surface of the lateral mass of atlas were measured by three dimension CT reconstruction and DR postoperatively to analyze the match between fixation system and atlantoaxial.Results The titanium plate and atlantoaxial surface were matching,without exceeding the edge.All the screws were within the bone,wihout any injuries of vertebral artery,spinal cord,and atlanto-occipital joint;The angle of the atlantoaxial transarticular screw trajectory was （23.22±1.71）° lateral angulation in coronal plane and （27.96±3.05）° posterior angulation in sagittal plane,the length was （27.50±1.55）mm,the angle of atlantoaxial screw trajectory was （9.55±0.80）°inner angulation in horizontal plane and （25.35±2.36）° upper angulation in sagittal plane,the length was （15.47±0.89）mm.The shortest distance between atlantoaxial transarticular screw and vertebral artery、spinal cord was in horizontal plane A（the upper edge of the transverse foramen of atlas）,with interval of （5.05±1.04）mm and （8.05±0.92）mm respectively;with an interval of （3.15±0.67）mm between atlantoaxial transarticular screw and the upper articular surface of the lateral mass of atlas.Conclution The technique of anterior atlantoaxial transarticular anatomic locking titanium plate screw fixiation system in atlantoaxial fixation is feasible in clinic.