中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (9): 1399-1402.doi: 10.12307/2023.925

• 骨科植入物 orthopedic implant • 上一篇    下一篇

新型成人后路寰椎骨折钉板复位内固定系统的设计

牛河钢，杨  昆，张晶晶，闫怡竹，张银顺   

  1. 安徽医科大学第一附属医院脊柱外科，安徽省合肥市   230022
  • 收稿日期:2022-12-19 接受日期:2023-02-11 出版日期:2024-03-28 发布日期:2023-07-25
  • 通讯作者: 张银顺，博士，副教授，主任医师，硕士生导师，安徽医科大学第一附属医院脊柱外科，安徽省合肥市 230022
  • 作者简介:牛河钢，男，1999年生，河南省平顶山市人，汉族，安徽医科大学在读硕士，主要从事脊柱外科的研究。
  • 基金资助:
    安徽省转化医学研究院(2021zhyx-C34)，项目负责人：张银顺；安徽省高等学校自然科学研究重点项目(KJ2019A0242)，项目负责人：张银顺

Design of a new posterior atlas fracture reduction and internal fixation system

Niu Hegang, Yang Kun, Zhang Jingjing, Yan Yizhu, Zhang Yinshun   

  1. Department of Spinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • Received:2022-12-19 Accepted:2023-02-11 Online:2024-03-28 Published:2023-07-25
  • Contact: Zhang Yinshun, MD, Associate professor, Chief physician, Master’s supervisor, Department of Spinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • About author:Niu Hegang, Master candidate, Department of Spinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • Supported by:
    Anhui Institute of Translational Medicine, No. 2021zhyx-C34 (to ZYS); Key Natural Science Research Project of Anhui Provincial Institutions of Higher Learning, No. KJ2019A0242 (to ZYS)

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摘要：


文题释义：

寰椎单椎节复位固定术：寰椎单节段内固定有经口前路手术、后路寰椎单椎节固定术、前后联合入路等术式。这种新的手术方式可有效避免因传统融合手术导致的颈椎生理运动功能丧失，重建上颈椎稳定。
寰椎爆裂性骨折：多因暴力由颅骨向颈椎轴向传递，作用于侧块上的垂直压力转化为水平向外的应力，导致寰椎前、后弓与侧块连接处最薄弱的部位发生骨折和移位。由于暴力作用的大小、方向及受力点不同，其骨折类型呈多样性，常伴有横韧带损伤。


背景：目前临床上一直缺乏复位良好、操作简便的后路单节段固定治疗寰椎爆裂性骨折的内固定系统。

目的：基于寰椎CT测量数据设计并优化一种符合人体局部解剖结构特征，操作简便且复位优良的新型后路寰椎骨折钉板复位内固定
系统。
方法：回顾性分析了347例成人的CT图像，在图像上依次测量内倾角0°经后弓侧块螺钉轨迹长度、最大内侧倾斜角与此时经后弓侧块螺钉轨迹的长度、寰椎椎动脉沟底部后弓高度、两侧经后弓侧块螺钉进针点距正中矢状面的距离、寰椎后弓半径、寰椎后结节至枕骨大孔后缘和寰椎后结节至枢椎椎弓上表面的距离，分析数据并设计优化一种符合人体解剖学特征的寰椎骨折复位内固定系统。

结果与结论：①所有受试者两侧的内倾角0°螺钉轨迹长度、最大内倾角度、最大内倾角螺钉轨迹长度、寰椎椎动脉沟底部后弓高度、进钉点至正中矢状面距离、寰椎后弓外侧缘半径、寰椎后结节至枕骨大孔后缘距离、寰椎后结节至枢椎棘突上表面距离的差异均无显著性意义(P > 0.05)，上述各指标在男性与女性组间比较差异均有显著性意义(P < 0.05)；②研究成功设计了新型寰椎骨折复位内固定系统，并获得国家专利；该内固定系统适合寰椎后弓解剖学特征，既可有效治疗寰椎爆裂性骨折，又可保留枕寰枢关节运动功能。

https://orcid.org/0000-0002-9034-0126 (牛河钢) 

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: 寰椎骨折内固定, 寰椎解剖, CT图像测量, 内固定系统设计

Abstract: BACKGROUND: At present, there is a lack of an internal fixation system with good reduction and simple operation for the treatment of atlas burst fracture by posterior single-segment fixation.
OBJECTIVE: Based on the atlas CT measurement data, a new posterior atlas fracture reduction and internal fixation system was designed and optimized, which was in line with the characteristics of human local anatomical structure, easy to operate and with good reduction.
METHODS: CT images of 347 adults were analyzed retrospectively. In the images, the length of pedicle screw track with a medial inclination of 0°, the angle of the maximum medial inclination angle and the length of pedicle screw track at this time, the height of vertebral artery groove, the distance between the entry points of bilateral pedicle screws and the midline, the radius of the posterior arch of atlas, the distance between the posterior tubercle of the atlas and the posterior edge of the foramen magnum, and the distance between the posterior tubercle of the atlas and the upper surface of the axial arch were measured. The imaging data were analyzed and a reduction and internal fixation system was designed and optimized for atlas fracture in line with human anatomical characteristics. 
RESULTS AND CONCLUSION: (1) There was no statistically significant difference in the the length of pedicle screw track with a medial inclination of 0°, the maximum medial inclination angle and the length of pedicle screw track at this time, the height of vertebral artery groove, the distance between the entry points of bilateral pedicle screws and the midline, the radius of the posterior arch of atlas, the distance between the posterior tubercle of the atlas and the posterior edge of the foramen magnum, and the distance between the posterior tubercle of the atlas and the upper surface of the axial arch measured on the left and right sides of all subjects (P > 0.05). There were statistically significant differences in each index measured between the male and female groups (P < 0.05). (2) The new posterior atlas fracture reduction and internal fixation system has been successfully designed and obtained the national patent. The internal fixation system is suitable for the anatomical characteristics of the posterior arch of the atlas. It can not only effectively treat the atlas burst fracture, but also retain the movement function of the occipital atlantoaxial joint.  

Key words: internal fixation of atlas fracture, atlas anatomy, CT image measurement, internal fixation system design

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