经口咽前路寰枢椎复位钢板系统的研制与初步临床应用

目的 研制经口咽前路寰枢椎复位钢板系统(TARP),评价其生物力学性能,并进行初步的临床应用观察。方法研制设计一种新型的经口咽前路寰枢椎复位钢板系统,该系统包括蝶形钛合金钢板、自锁螺钉和寰枢椎复位器等配套安装器械。将此系统在12具枕骨～C3新鲜标本卜分别进行了三维运动测试(n=6)和拔出力实验(n=12),比较其生物力学性能,并初步临床应用3例。结果TARP系统设计有巧妙的即时复位饥制。 TARP、Brooks钢丝、Magerl经关节螺钉、前路螺钉以及Brooks钢丝 Magerl经关节螺钉等5组在屈伸方向的平均活动范同分别为4．0、6．2、5．1、6．6、3．7度;在侧屈方向的平均活动范围分别为2．3、3．6、2．7、4．2、1．8度;平均旋转活动范围分别为7．4、8．9、8．6、10．7、6．0度。结果显示TARP的生物力学性能与Brooks钢丝 Magerl经关节螺钉固定等效,较其他3种方法具有更坚强的固定作用。临床应用术后随访平均8．3个月,3例寰椎完全复位,伤口愈合良好,无感染,四肢麻痹消失,肌力恢复,病理反射消失?钢板螺钉未松动。结论TARP设计新颖独到,具有良好的生物力学性能,手术操作简便易行,能达到即时复位,固定效果好,具有良好的应用前景。

Design and preliminary clinical application of transoralpharyngeal atlantoaxial reduction plate

OBJECTIVE: To design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect. METHODS: A brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported. RESULTS: The reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant. CONCLUSION: TARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.