中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4289-4293.doi: 10.12307/2021.184

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

1-6岁儿童经斜坡置入内固定钛板：力学支撑的数字化形态学分析

李  琨，李志军，张少杰，高  尚，王  星，孙  昊，和雨洁，王海燕，蔡永强，徐雪彬   

  1. 内蒙古医科大学，1人体解剖学教研室，2数字医学中心，3学生管理处，内蒙古自治区呼和浩特市   010000
  • 收稿日期:2020-10-17 修回日期:2020-10-21 接受日期:2020-12-14 出版日期:2021-09-28 发布日期:2021-04-10
  • 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 010059 张少杰，教授，研究生导师，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 010059
  • 作者简介: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。 王星，男，1979年生，内蒙古自治区呼和浩特市人，汉族，在读博士，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；内蒙古医科大学英才培育项目(YCPY20200090，YCPY20200002)，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(20201032001)，项目负责人：李琨；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(2020MS03061)，项目负责人：王星；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

Titanium plate placement for internal fixation of slopes in children aged 1-6 years: digital morphological analysis of mechanical support

Li Kun, Li Zhijun, Zhang Shaojie, Gao Shang, Wang Xing, Sun Hao, He Yujie, Wang Haiyan, Cai Yongqiang, Xu Xuebin    

  1. 1Department of Human Anatomy, 2Digital Medical Center, 3Student Management Office, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • Received:2020-10-17 Revised:2020-10-21 Accepted:2020-12-14 Online:2021-09-28 Published:2021-04-10
  • 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, Inner Mongolia Medical University, Hohhot 01000, 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 Wang Xing, Doctoral candidate, Department of Human Anatomy, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81860382 (to WX), No. 81860383 (to LZJ), No. 81660358 (to ZSJ); the Research and Innovation Fund for Postgraduates in Inner Mongolia Autonomous Region, No. S2018112010Z (to LK); the Talent Cultivation Project of Inner Mongolia Medical University, No. YCPY20200090, YCPY20200002 (to LK); the Laboratory Opening Project of Inner Mongolia Medical University, No. 2020ZN48 (to LK); the Innovation and Entrepreneurship Project of Inner Mongolia Medical University, No. 20201032001 (to LK); the Enlightenment Plan of Inner Mongolia Medical University, No. FYQMJH2020034 (to LK); the Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2020MS03061 (to WX), No. 2020LH08021 (to LZJ), No. 2019MS08017 (to ZSJ)  

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摘要：

文题释义：
斜坡：位于颅底枕骨大孔前上方的平坦斜面，由枕骨和蝶骨构成，两骨交界处为蝶枕裂隙。幼儿蝶枕裂隙未骨化称为蝶枕软骨结合。
枕寰枢复合体：枕颈区由C0-C2的寰枕关节、寰枢正中(寰齿关节)和外侧关节及周围关节软骨、韧带等软组织等构成，其作为连接颅脑与上颈椎的重要枢纽和力学桥梁，结构特殊、功能复杂，可灵活地满足头颈部多维运动并提供必要的力学支撑，以保护生命中枢脑干及周围血管、神经等重要结构。

背景：枕颈区不稳是由骨性或软组织结构异常或损伤造成的，而临床中患者枕颈区后方或前方上颈椎骨质破损时，需行经前路颅骨斜坡内固定，目前此手术方式多用于成人。迄今国内外尚无儿童在此区域的共性化置钉发育解剖数据(内固定钛板大小、位置等)作为参考。
目的：研究1-6岁儿童斜坡及邻近解剖结构，为斜坡内固定钛板的放置提供详细资料。
方法：将110名1-6岁儿童颈椎CT原始数据分为1-2岁组(n=30)、3-4岁组(n=39)、5-6岁组(n=41)，运用Mimics软件行三维重建后测量颅外斜坡长、颅内斜坡长、斜坡底宽、咽结节距斜坡底距离等参数。
结果与结论：①斜坡各参数指标的均值随年龄增长均呈上升趋势，3组间颅内外斜坡长、颅内外蝶枕软骨结合距斜坡底距离、斜坡底宽、咽结节距斜坡底距离、破裂孔内侧缘距离比较差异均有显著性意义(P < 0.05)，5-6岁组的斜坡顶宽与1-2岁组、3-4岁组比较差异有显著性意义(P < 0.05)，3组间斜坡颈椎角比较差异无显著性意义(P > 0.05)；②在斜坡放置内固定钛板的尺寸为：1-2岁组钛板顶端宽8 mm、中部宽19.1 mm、底端宽26.9 mm、长23.7 mm；3-4岁组钛板顶端宽8.1 mm、中部宽20.6 mm、底端宽31.3 mm、长26.5 mm；5-6岁组钛板顶端宽10.4 mm、中部宽22 mm、底端宽37.3 mm、长28 mm；③根据斜坡区参数分析得出1-6岁儿童各年龄段放置斜坡钛板的尺寸，并帮助临床医师掌握斜坡解剖结构，提高钛板放置安全性。
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, 枕寰枢复合体, 斜坡, 钛板, 螺旋CT, 发育特征, 内固定

Abstract: BACKGROUND: Occipital neck instability is caused by bone or soft tissue structural abnormalities or injuries. In clinical practice, patients with posterior or anterior upper cervical bone fractures in the occipital neck region need to undergo anterior skull slope internal fixation, which is currently used in adults. Up to now, there is no common developmental anatomy data (size and position of titanium plate for internal fixation) of children in this area at home and abroad for reference.
OBJECTIVE: To study the slope and adjacent anatomical structures of children aged 1-6 years, and to provide detailed information for placement of titanium plates for internal fixation of slopes.
METHODS:  The original cervical CT data of 110 children aged 1-6 years were divided into three groups: 1-2-year group (n=30), 3-4-year group (n=39) and 5-6-year group (n=41). Mimics software was used for three-dimensional reconstruction to measure the parameters such as the length of the extracranial slope, the length of the intracranial slope, the width of the bottom of the slope, and the distance between the pharyngeal tuberculum and the bottom of the slope.  
RESULTS AND CONCLUSION: (1) The mean slope of each parameter was on the rise along with the age growth. Differences in intracranial slope length, intracranial external adjustment pillow cartilage combined with distance from the bottom of the slope, slope bottom width, pharynx nodules from the bottom of the slope distance, and broken hole inside edge distance were significant among the three groups (P < 0.05). Slope top width was significantly different between 5-6-year group and the 1-2-year and 3-4-year groups (P < 0.05). The slope angle of cervical spine was not significantly different among the three groups (P > 0.05). (2) The dimensions of titanium plates for internal fixation placed on the slope were: the top width of titanium plate was 8 mm; the middle width was 19.1 mm; the bottom width was 26.9 mm; and the length was 23.7 mm in the 1-2-year group. The top width of titanium plate was 8.1 mm; the middle width was 20.6 mm; the bottom width was 31.3 mm; and the length was 26.5 mm in the 3-4-year group. The top width of titanium plate was 10.4 mm; the middle width was 22 mm; the bottom width was 37.3 mm; and the length was 28 mm in the 5-6-year group. (3) According to the analysis of slope area parameters, the sizes of titanium plates placed on slopes for children aged 1-6 years were obtained, which helped clinicians master the slope anatomical structure and improve the safety of titanium plates placed.

Key words: children, occipitoatlantoaxial complex, slope, titanium plate, spiral CT, developmental characteristics, internal fixation

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