中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (36): 5804-5809.doi: 10.12307/2021.346

• 脊柱植入物 spinal implant • 上一篇    下一篇

学龄前期儿童行寰椎椎弓根或侧块螺钉内固定的可行性

熊  峰1，李  琨2，周书宇3，王  鹏4，党业兴4，李志军2，张少杰2   

  1. 内蒙古医科大学，1鄂尔多斯临床医学院，2人体解剖学教研室，3中医学院，4第一临床医学院，内蒙古自治区呼和浩特市   010000
  • 收稿日期:2021-03-05 修回日期:2021-03-06 接受日期:2021-04-10 出版日期:2021-12-28 发布日期:2021-09-17
  • 通讯作者: 李志军，教授，博士生导师，内蒙古医科大学基础医学院解剖学教研室，内蒙古自治区呼和浩特市 010000 张少杰，教授，硕士生导师，内蒙古医科大学基础医学院解剖学教研室，内蒙古自治区呼和浩特市 010000
  • 作者简介:熊峰，男，1999年生，内蒙古自治区呼伦贝尔市人，汉族，主要从事脊柱与脊髓的数字化研究。 李琨，女，1988 年生，内蒙古自治区呼和浩特市人，汉族，硕士，主要从事脊柱与脊髓的数字化研究。
  • 基金资助:
    国家自然科学基金(81860383)，项目负责人：李志军；国家自然科学基金 (81660358)，项目负责人：张少杰；内蒙古自治区研究生科研创新基金项目(S2018112010Z)，项目负责人：李琨；内蒙古医科大学实验室开放项目(2020ZN48)，项目负责人：李琨；内蒙古医科大学大学生创新创业项目(202010132001)，项目负责人：熊峰；内蒙古医科大学启蒙计划(FYQMJH2020034)，项目负责人：李琨；内蒙古自然科学基金资助项目 (2020LH08021)，项目负责人：李志军；内蒙古自然科学基金资助项目(2019MS08017)，项目负责人：张少杰；内蒙古自治区科技发展计划项目(2019GG158)，项目参与人：李琨；内蒙古医科大学青年创新基金项目(YKD2020QNCX055)，项目负责人：李琨

Feasibility of atlantoaxial pedicle screw or lateral mass screw fixation in preschool children

Xiong Feng1, Li Kun2, Zhou Shuyu3, Wang Peng4, Dang Yexing4, Li Zhijun2, Zhang Shaojie2   

  1. 1Ordos Clinical College, 2Department of Human Anatomy, 3College of Traditional Chinese Medicine, 4First Clinical College, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • Received:2021-03-05 Revised:2021-03-06 Accepted:2021-04-10 Online:2021-12-28 Published:2021-09-17
  • Contact: Li Zhijun, Professor, Doctoral supervisor, Department of Human Anatomy, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China Zhang Shaojie, Professor, Master’s supervisor, Department of Human Anatomy, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • About author:Xiong Feng, Ordos Clinical College, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China Li Kun, Master, Department of Human Anatomy, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • Supported by:
    National Natural Science Foundation of China, No. 81860383 (to LZJ); National Natural Science Foundation of China, No. 81660358 (to ZSJ); Graduate Research and Innovation Fund of Inner Mongolia Autonomous Region, No. S2018112010Z (to LK); Laboratory Open Project of Inner Mongolia Medical University, No. 2020ZN48 (to LK); College Student Innovation and Entrepreneurship Program of Inner Mongolia Medical University, No. 202010132001 (to XF); Inner Mongolia Medical University Enlightenment Program, No. FYQMJH2020034 (to LK); Inner Mongolia Natural Science Foundation of China, No. 2020LH08021 (to LZJ); Inner Mongolia Natural Science Foundation of China, No. 2019MS08017 (to ZSJ); Science and Technology Development Program of Inner Mongolia Autonomous Region, No. 2019GG158 (to LK); Youth Innovation Fund Project of Inner Mongolia Medical University, No. YKD2020QNCX055 (to LK)

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摘要：


文题释义：

寰椎：即第一颈椎，位于脊柱顶端与枕骨相连处，是头颈部重要枢纽和力学桥梁，外观呈环形，无椎体，由前后弓和两侧块构成，可灵活地满足头颈部多维运动并提供力学支撑，其内走行脊髓，其周走行椎血管、神经根等重要软组织结构。
螺钉内固定：内固定螺钉依靠其螺纹和骨质密切结合，深入骨皮质，较好地达到保持复位与内固定的作用，适用于撕裂骨折，特别是累及关节面的骨折，其骨折碎片小，肌肉的牵拉力量大，外固定难以保持复位。螺钉内固定术具有切口小、对软组织的损伤小、异物感少等优点。

背景：在治疗枕颈区寰椎骨折患者时需行椎弓根或侧块内固定术，此手术多用于成人骨折。迄今国内外尚无学龄前期儿童在寰椎的共性化内固定置钉发育解剖数据。
目的：观测学龄前期儿童寰椎形态结构，探索1-6岁儿童寰椎椎弓根或侧块置入3.50 mm螺钉进行内固定的可行性。
方法：在内蒙古医科大学附属医院、内蒙古医科大学第二附属医院和赤峰市医院收集54例1-6岁儿童头颈部螺旋CT扫描的影像资料，每2岁一组分为3组(1-2岁组、3-4岁组、5-6岁组)。将DICOM数据导入Mimics 17.0行三维重建，运用测量工具在影像资料和重建模型中测量寰椎各参数指标，并行统计学分析。

结果与结论：①各年龄段组儿童的寰椎各参数左右侧间比较差异均无显著性意义(P > 0.05)；②寰椎各指标随年龄增长呈上升趋势，其中椎弓根宽、椎弓根进钉点距中心线水平距离、椎弓根外偏角、尾偏角、侧块横径、侧块进钉点距中心线水平距离、侧块内倾角、上倾角在3组间比较有显著性意义(P < 0.05)；③椎弓根置钉的主要限制因素是椎弓根宽(AW)和椎弓根高(AH)，测量结果显示椎弓根宽>椎弓根高，1-2岁组、3-4岁组、5-6岁组的椎弓根高分别为(4.23±0.46)，(5.09±0.46)，(5.47±0.69) mm，侧块钉无明显限制；④提示：1-6岁儿童寰椎椎弓根或侧块均具有置入3.50 mm螺钉的可行性，但不同年龄儿童的置钉角度、位置、进钉长度应有所差异，临床操作需进行影像扫描及个体化制定手术方案。

 https://orcid.org/0000-0003-2407-7670 (熊峰)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 儿童, 寰椎, 数字化, CT扫描, 解剖结构, 形态测量, 发育特征, 内固定

Abstract: BACKGROUND: In the treatment of occipitocervical atlas fractures, pedicle or lateral mass internal fixation is usually performed for adult fractures. There are no anatomic data on the development of common internal fixation screws in atlas in pre-school age children.  
OBJECTIVE: To investigate the feasibility of 3.50 mm screw placement in atlas pedicle or lateral mass in 1-6-year-old children by observing morphological structure of atlas.
METHODS:  Head and neck imaging data of 54 children aged 1-6 years were collected from Affiliated Hospital of Inner Mongolia Medical University, Second Affiliated Hospital of Inner Mongolia Medical University and Chifeng Hospital, and divided into three groups (1-2 year-old group, 3-4 year-old group, 5-6 year-old group). Three-dimensional reconstruction was performed by importing DICOM data into MIMICS17.0. All parameters of atlas were measured by measuring tools in image data and reconstruction model, and analyzed statistically.  
RESULTS AND CONCLUSION: (1) Atlas parameters had no statistical difference between left and right sides in each group (P > 0.05). Each index of atlas was on the rise along with the age growth. The pedicle width, pedicle nail into point away from the center line of the horizontal distance, pedicle angle, tail angle, lateral horizontal diameter, side piece into the nail points away from the center line of the horizontal distance, lateral block angle, and the upper tilting angle were statistically significant among groups (P < 0.05). (3) The main limiting factor of pedicle was pedicle width and pedicle height. Measurement results showed that the pedicle width > pedicle height. Pedicle heights were (4.23±0.46), (5.09±0.46), and (5.47±0.69) mm in the 1-2 year-old group, 3-4 year-old group, and 5-6 year-old group, respectively. There was no obvious limitation of lateral mass screws. (4) It is indicated that 3.50 mm screws can be inserted into the pedicle or lateral mass of atlas in children aged 1-6 years, but the angle, position and length should be different in children of different ages. Imaging scan and individualized surgical plan should be carried out for clinical operation.

Key words: children, atlas, digital, CT, anatomical structure, morphological measurement, developmental characteristics, internal fixation

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