中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (9): 1383-1387.doi: 10.12307/2022.433

• 脊柱植入物Spinal implants • 上一篇    下一篇

1-6岁儿童枢椎经椎弓根螺钉内固定的可行性

李  琨1,高尔科2,熊  峰3,王  星1,3,武丹琪2,李志军1,3,张少杰1,3,刘亚楠2,朵  岚2,李子瑜2   

  1. 内蒙古医科大学,1人体解剖学教研室,2研究生学院,3数字医学中心,内蒙古自治区呼和浩特市   010000
  • 收稿日期:2021-05-22 修回日期:2021-05-25 接受日期:2021-07-28 出版日期:2022-03-28 发布日期:2021-12-10
  • 通讯作者: 李志军,教授,博士生导师,内蒙古医科大学人体解剖学教研室,内蒙古医科大学数字医学中心,内蒙古自治区呼和浩特市 010000 张少杰,教授,硕士生导师,内蒙古医科大学人体解剖学教研室,内蒙古医科大学数字医学中心,内蒙古自治区呼和浩特市 010000
  • 作者简介:李琨,女,1988年生,汉族,内蒙古自治区呼和浩特市人,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(81860382),项目负责人:王星;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),项目负责人:王星;内蒙古医科大学青年创新基金项目(YKD2020QNCX055),项目负责人:李琨;内蒙古医科大学英才培育项目(YCPY2021050),项目参与人:熊峰

Feasibility of axial transpedicle screw internal fixation in children aged 1 to 6 years

Li Kun1, Gao Erke2, Xiong Feng3, Wang Xing1, 3, Wu Danqi2, Li Zhijun1, 3, Zhang Shaojie1, 3, Liu Yanan2, Duo Lan2, Li Ziyu2   

  1. 1Department of Human Anatomy, 2Graduate School, 3Digital Medical Center, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • Received:2021-05-22 Revised:2021-05-25 Accepted:2021-07-28 Online:2022-03-28 Published:2021-12-10
  • Contact: Li Zhijun, Professor, Doctoral supervisor, Department of Human Anatomy, and Digital Medical Center, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China Zhang Shaojie, Professor, Master’s supervisor, Department of Human Anatomy, and Digital Medical Center, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • About author: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. 81860382 (to WX); National Natural Science Foundation of China, No. 81860383 (to LZJ); National Natural Science Foundation of China, No. 81660358 (to ZSJ); Graduate Research in Inner Mongolia Autonomous Region Innovation Fund Project, No. S2018112010Z (to LK); Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2020LH08021 (to LZJ); Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2019MS08017 (to ZSJ); Science and Technology Development Planned Project of Inner Mongolia Autonomous Region, No. 2019GG158 (to WX); Youth Innovation Fund Project of Inner Mongolia Medical University, No. YKD2020QNCX055 (to LK); Talent Cultivation Project of Inner Mongolia Medical University, No. YCPY2021050 (to XF)

摘要:

文题释义:
枢椎:即第2颈椎,是颈椎中最坚固的椎骨,其椎体上有向上伸出的齿突与寰椎前弓的齿突凹相关节,以适应头颈部的旋转运动,枢椎的椎体较其他颈椎小,但椎弓根短而粗,横突短小且末端不分叉,椎板厚而坚固,其棘突较下位椎骨的棘突长而大。
螺钉内固定技术:凭借着植入螺钉纹理与骨质内部的紧密咬合达到良好固定、复位效果,此技术可以恢复骨支架,防止压缩变形,同时具有切口小、剥离骨膜少、对骨组织及周围软组织创伤少、异物感小、操作简单等优点。

背景:在治疗枕-寰-枢复合体区枢椎椎弓根特异性骨折时患者需行螺钉内固定,这种方法在成年人中应用较广泛,对于1-6岁儿童在枢椎椎弓根的共性化内固定置钉,国内外尚无发育解剖数据。
目的:探讨1-6岁儿童枢椎经椎弓根行3.50 mm螺钉内固定的可行性。
方法:入选1-6岁儿童45例,每隔2岁为1组,分为1-岁组,3-岁组,5-6岁组,每组15例,获取颈椎CT原始数据,行三维重建后测量椎弓根上、中、下缘宽,椎弓根高和长,置钉内倾角及上倾角等参数。每例均测双侧椎弓根相关指标参数,每个参数指标测量3次,取平均值。
结果与结论:①枢椎椎弓根各指标除上倾角和内倾角随年龄增长呈下降趋势外,其余各指标均呈上升趋势;②同年龄组间椎弓根上缘宽、椎弓根中缘宽、椎弓根下缘宽互相比较,差异均有显著性意义;③限制枢椎椎弓根螺钉置钉及稳定性的主要因素是椎弓根中缘宽和长,椎弓根中缘宽:1-岁组为(4.26±0.68) mm,3-岁组为(4.92±0.83) mm,5-6岁组为(6.26±1.26) mm;椎弓根长:1-岁组为(12.38±2.10) mm,3-岁组为(21.00±5.39) mm,5-6岁组为(24.62±1.11) mm;④结果表明,1-6岁儿童枢椎椎弓根具有置入3.50 mm螺钉的可行性,不同年龄组置钉方式应有所不同。

https://orcid.org/0000-0002-8329-3368 (李琨) 

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, 枢椎椎弓根, 数字化测量, 螺钉内固定, 螺旋CT, 解剖形态

Abstract: BACKGROUND: Internal screw fixation is often required for the treatment of specific axial pedicle fractures in the occipito-atlanto-axial complex region and is widely used in adults. However, there are no anatomic data on the development of the axial pedicle with common internal fixation in children aged 1 to 6 years.  
OBJECTIVE: To investigate the feasibility of 3.50 mm perpedicle screw internal fixation of axial vertebrae in children aged 1 to 6 years.
METHODS:  Totally 45 children aged 1 to 6 years were selected and divided into three groups: 1-year-old group, 3-year-old group, 5-6-year-old group, with 15 cases in each group. The original cervical CT data were obtained. The width of the upper, middle and lower edges of the vertebral pedicle, the height and length of the vertebral pedicle, the inclination angle and the upclination angle of the screw were measured after three-dimensnioal reconstruction. In each case, the related index parameters of bilateral pedicle were measured, and each parameter index was measured three times, and the average value was taken.  
RESULTS AND CONCLUSION: (1) All the indexes of axial pedicle showed an increasing trend with age, except the upper inclination and inner inclination. (2) The width of the upper edge of the vertebral pedicle, the width of the middle edge of the vertebral pedicle and the width of the lower edge of the vertebral pedicle were significantly different among the same age groups. (3) The main limiting factors of axial pedicle screw insertion and stability were the median edge width and length of the vertebral pedicle. The median edge width of the vertebral pedicle was (4.26±0.68) mm in 1-year-old group, (4.92±0.83) mm in 3-year-old group, and (6.26±1.26) mm in 5-6-year-old group. The pedicle length was (12.38±2.10) mm in 1-year-old group, (21.00±5.39) mm in 3-year-old group, and (24.62±1.11) mm in 5-6-year-old group. (4) These results confirm the feasibility of inserting 3.50 mm screws in the axial pedicle of children aged 1-6 years. The screw placement methods should be different in different age groups.

Key words: children, axial pedicle, digital measurement, screw internal fixation, spiral CT, anatomical shape

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