本文選題：寰樞椎不穩(wěn) + 前路�。� 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：寰樞椎不穩(wěn)是指寰樞椎結(jié)構(gòu)遭受外傷、畸形、腫瘤、炎癥破壞,喪失了正常的生理功能和穩(wěn)定性,導(dǎo)致寰樞椎脫位或半脫位,合并或繼發(fā)脊髓、神經(jīng)根或椎動脈的刺激及壓迫癥狀。造成寰樞椎不穩(wěn)的原因有：①先天性異常：如寰樞椎發(fā)育不良,齒狀突畸形,椎間關(guān)節(jié)和韌帶結(jié)構(gòu)的松弛、缺失或不對稱等；②創(chuàng)傷性：車禍、高處墜落傷致寰-樞椎體部骨折、寰-樞椎半脫位、Jefferson骨折、Hangman骨折、齒狀突骨折、陳舊性創(chuàng)傷致齒狀突假關(guān)節(jié)形成、急性韌帶損傷導(dǎo)致真性脫位、慢性韌帶損傷等；③病理性：類風(fēng)濕關(guān)節(jié)炎、強直性脊柱炎、上頸椎結(jié)核等；④腫瘤病變；⑤退行性疾病：骨關(guān)節(jié)炎等。其中以創(chuàng)傷性寰樞椎不穩(wěn)最常見。寰樞椎不穩(wěn)的臨床表現(xiàn)：①枕頸部疼痛；②斜頸；③頸髓、延髓損傷：癱瘓,呼吸困難甚至造成生命危險；④椎動脈損傷：影響腦部供血；⑤神經(jīng)根損傷：神經(jīng)支配區(qū)域相應(yīng)的體征；⑥病程長者,可有緩慢的進行性的肩胛帶、上肢及手內(nèi)在肌萎縮。寰樞椎不穩(wěn)具有嚴重的危險性,易引起上頸髓、神經(jīng)根、椎動脈受壓的癥狀和體征,可致四肢癱瘓,甚至危及生命,因此常常需手術(shù)治療。寰樞椎不穩(wěn)定目前臨床手術(shù)分為后路和前路內(nèi)固定。其中后路手術(shù)主要有：寰樞椎椎板下鋼絲技術(shù)、椎板夾技術(shù)、Magerl關(guān)節(jié)螺釘技術(shù)、后路寰椎側(cè)塊樞椎椎弓根釘棒技術(shù)。其中早期使用的寰樞椎椎板下鋼絲技術(shù)、椎板夾技術(shù)生物力學(xué)性能差,寰椎后弓要求完整,固定不可靠；Magerl關(guān)節(jié)螺釘技術(shù)及后路寰椎側(cè)塊樞椎椎弓根釘棒系統(tǒng)力學(xué)性能改善,固定可靠,但其對上頸椎先天性后側(cè)骨性結(jié)構(gòu)的缺失、醫(yī)源性后路骨性結(jié)構(gòu)切除、寰樞椎位置及大小的解剖學(xué)變異等病例,后路手術(shù)難以進行,需選擇前側(cè)入路手術(shù)。同時,后路手術(shù)對來自脊髓前方的壓迫或粘連無能為力,需前路手術(shù)減壓或松解,一期或二期后路內(nèi)固定,術(shù)中翻身可能造成致命的脊髓損傷,同時也增加了患者的住院費用。前路手術(shù)過去主要應(yīng)用于寰樞椎后側(cè)骨性結(jié)構(gòu)缺失或椎動脈異常而不適合施行后路手術(shù)治療的患者,但經(jīng)過近年的發(fā)展,現(xiàn)已用于各種寰樞椎不穩(wěn)定,而且具有后路手術(shù)不具備的優(yōu)勢。前路經(jīng)口咽寰樞椎鈦板內(nèi)固定術(shù)在內(nèi)固定的同時可進行前側(cè)松解及減壓,臨床已廣泛用于新鮮及陳舊性創(chuàng)傷性寰樞椎不穩(wěn),并取得了一定的療效。但其致命不足在于該手術(shù)是在污染的情況下操作,容易感染,且術(shù)中一旦損傷硬脊膜,造成腦脊液漏,感染將難以控制甚至危及生命。因此,對于前路手術(shù),頜下入路成為一種新選擇,但目前尚無滿意的內(nèi)固定器械。如經(jīng)樞椎椎體寰椎側(cè)塊螺釘內(nèi)固定,其進釘時需較大后傾角,容易損傷脊髓與椎動脈,且對樞椎椎體完整性要求較高。寰樞椎前路經(jīng)關(guān)節(jié)螺釘內(nèi)固定,釘?shù)涝跇凶刁w和寰椎側(cè)塊中由前內(nèi)向后外走行,可避免向內(nèi)穿入椎管損傷脊髓,與椎動脈毗鄰不密切,損傷脊髓或椎動脈的風(fēng)險降低。寰樞椎前路經(jīng)關(guān)節(jié)螺釘內(nèi)固定術(shù)目前在我院已推廣,取得了較為滿意的效果,但該技術(shù)的生物力學(xué)性能有待進一步提高,而且對樞椎前側(cè)骨質(zhì)要求高,若為骨質(zhì)疏松,螺釘易松動脫出,操作困難,寰椎側(cè)塊粉碎性骨折者不適宜應(yīng)用此術(shù)式。前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)是我們研制的具有自主知識產(chǎn)權(quán)的寰樞椎前路內(nèi)固定系統(tǒng)(專利號：ZL 2011 2 0134687.X),該系統(tǒng)有復(fù)位及鎖定功能,采用頜下手術(shù)入路,在前路松解、減壓的同時行一期內(nèi)固定,簡化了手術(shù)操作,增強了內(nèi)固定的可靠性。本課題通過建立該系統(tǒng)的手術(shù)模型,觀察此內(nèi)固定系統(tǒng)與寰樞椎復(fù)合體的吻合程度,測定新鮮頸椎標本在失穩(wěn)條件下行前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定后前屈、后伸、左右側(cè)彎、左右旋轉(zhuǎn)方向的運動范圍,探討失穩(wěn)寰樞椎行此內(nèi)固定的三維穩(wěn)定性和安全性,為前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)在臨床上的推廣應(yīng)用提供理論依據(jù)。第一部分前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)的三維穩(wěn)定性研究目的通過在新鮮頸椎尸體標本上進行模擬手術(shù),然后在脊柱三維運動機上進行力學(xué)實驗來評價前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定治療寰樞椎不穩(wěn)的三維穩(wěn)定性,從而為該內(nèi)固定術(shù)式在臨床上的推廣應(yīng)用提供生物力學(xué)依據(jù)。方法8具意外死亡的成年男性頸椎新鮮標本,排除各項頸椎疾患,取材后剔除頸部肌肉組織,保留完整的韌帶和關(guān)節(jié)囊,制成枕骨至頸4椎體(C0～C4)完整狀態(tài)的實驗標本。用聚甲基丙烯酸甲酯(牙托粉)包埋,上方包埋至C0,下方包埋至c4,放于-20℃的冰箱中保存?zhèn)溆谩?具標本分別編號,對每具標本分別進行完整狀態(tài)、齒狀突Ⅱ型骨折、前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定、后路寰樞椎椎弓根螺釘固定四種狀態(tài)下的三維運動范圍測定。每具標本先進行正常狀態(tài)下的三維運動范圍測定,再將標本造成寰樞椎不穩(wěn)定(齒狀突Ⅱ型骨折),測試標本在齒狀突Ⅱ型骨折狀態(tài)下的三維運動范圍。再對每一標本分別行前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定和后路寰樞椎椎弓根螺釘固定,并測定在不同狀態(tài)下的三維運動范圍。為消除同一標本由于固定方式的先后順序?qū)嶒灲Y(jié)果造成的影響,前、后路固定的先后順序隨機進行。生物力學(xué)測試標本的三維運動測試在非破壞方式下在脊柱三維運動試驗機Spine2000(精確度0.01Nm)上進行,標本定標后,施加2.0Nm的純力偶矩。通過對標本加載、卸載載荷2.0Nm,測量標本不同狀態(tài)下的前屈、后伸、左側(cè)彎、右側(cè)彎及左、右旋轉(zhuǎn)等6個運動方向的運動幅度。各方向加載3次,前2次為消除蠕變影響,第3次精確測量各運動方向的角度位移作為基準值,從而確定標本的運動范圍(range of motion,ROM)。由激光三維掃描儀掃描寰樞椎在零載荷至最大載荷狀態(tài)下的運動情況,記錄并輸入計算機,分別計算出正常、齒狀突Ⅱ型骨折、前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定及后路寰樞椎椎弓根螺釘固定的ROM。結(jié)果前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定和后路寰樞椎椎弓根螺釘固定的寰樞椎三維運動范圍明顯小于正常狀態(tài)和齒狀突Ⅱ型骨折狀態(tài)(P0.000)；齒狀突Ⅱ型骨折組寰樞椎的前屈、后伸、左右側(cè)彎及左右旋轉(zhuǎn)運動范圍較正常組有顯著性差異(P0.000)。前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定和后路寰樞椎椎弓根螺釘固定的寰樞椎三維運動范圍無顯著統(tǒng)計學(xué)差異(前屈P=0.930,后伸P=0.952,左右側(cè)彎P=0.947,左右旋轉(zhuǎn)P=0.950)。前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定和后路寰樞椎椎弓根螺釘固定在前屈、后伸、左右側(cè)彎及左右旋轉(zhuǎn)的ROM穩(wěn)定指數(shù)均無顯著差異(P0.05),二者的三維穩(wěn)定性均較好。但前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘固定的寰樞椎三維運動范圍較后路寰樞椎椎弓根螺釘固定稍大。結(jié)論前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定的寰樞椎三維運動范圍均明顯小于正常和齒狀突Ⅱ型骨折(P0.000),與后路椎弓根螺釘固定的寰樞椎三維運動運動范圍無統(tǒng)計學(xué)差異。前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)后的前屈運動范圍為(1.39±0.26)。,后伸運動范圍為(1.40±0.22)。,側(cè)彎運動范圍為(1.43±0.23)。,旋轉(zhuǎn)運動范圍為(1.77±0.34)。,能即刻穩(wěn)定寰樞椎復(fù)合體,明顯減小寰樞關(guān)節(jié)各方向的運動范圍,具有良好的生物力學(xué)性能。第二部分前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)的解剖學(xué)安全性研究目的通過在新鮮頸椎失穩(wěn)標本行前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定模擬手術(shù),并分析術(shù)后經(jīng)CT三維重建獲得的解剖測量數(shù)據(jù),評價此內(nèi)固定系統(tǒng)在臨床應(yīng)用方面的解剖學(xué)安全性。方法8具意外死亡的成年男性頸椎新鮮標本,經(jīng)同前處理后,行前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定模擬手術(shù)(具體過程見前),術(shù)畢用多層螺旋CT(MSCT)對8具手術(shù)模型行2.0mm層厚掃描,將獲取的原始數(shù)據(jù)傳至Vitrea 2工作站行CT三維重建技術(shù)中的多平面重建(MPR)和容積重建(VR),多平面重建(MPR)后的圖像用Vitrea 2工作站自帶的測量軟件測量不同平面上經(jīng)寰樞關(guān)節(jié)螺釘與椎動脈及脊髓的距離、釘尖距寰椎側(cè)塊上關(guān)節(jié)面的距離,同時行數(shù)字化攝影(DR),分析前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)臨床應(yīng)用的解剖學(xué)安全性。結(jié)果前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)后X線片檢查顯示鎖定鈦板與樞椎體吻合良好,螺釘均在骨質(zhì)內(nèi),未進入椎管和橫突孔。多層螺旋CT(MSCT)掃描結(jié)果顯示在橫截面A(寰椎橫突孔上緣)經(jīng)寰樞關(guān)節(jié)螺釘距椎動脈(椎管壁)和脊髓(橫突孔內(nèi)側(cè)壁)最近,分別為(5.35±1.02)mm和(8.55±0.93)mm,與寰椎側(cè)塊上關(guān)節(jié)面距離為(3.45±0.64)mm；橫截面B(寰椎橫突孔下緣)螺釘與椎動脈和脊髓的距離分別為(5.55±0.99)mm和(8.15±1.03)mm。橫截面C(樞椎上關(guān)節(jié)面下緣)螺釘與椎動脈和脊髓的距離分別為(9.75±1.21)mm和(10.95±1.02)mm。結(jié)論前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)能即刻穩(wěn)定寰樞椎復(fù)合體,在寰樞椎骨質(zhì)內(nèi)有足夠的置釘空間,未傷及椎動脈和脊髓；采用前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)行寰樞椎固定在解剖上是安全可行的,所以前路經(jīng)寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定系統(tǒng)在臨床應(yīng)用的安全性良好。
[Abstract]:Atlantoaxial instability refers to the atlantoaxial structure suffering from trauma, malformation, tumor, inflammatory destruction, loss of normal physiological function and stability, leading to atlantoaxial dislocation or subluxation, combined or secondary spinal cord, nerve root or vertebral artery irritation and compression symptoms. Good, odontoid deformity, relaxation, loss or asymmetry of the structure of the intervertebral joints and ligaments; (2) traumatic: accident, the atlantoaxial fracture, atlantoaxial subluxation, Jefferson fracture, Hangman fracture, odontoid fracture, odontoid false joint formation, acute ligamentous dislocation, chronic toughening, and chronic toughening of acute ligament injury. Histopathological: rheumatoid arthritis, ankylosing spondylitis, upper cervical tuberculosis and so on; (4) tumor lesions; (5) degenerative disease: osteoarthritis. Among them, traumatic atlantoaxial instability is the most common. The clinical manifestations of atlantoaxial instability: (1) occipital and cervical pain; (2) torticollis; (3) cervical spinal cord, medulla injury: paralysis, dyspnea Even cause the risk of life; (4) vertebral artery injury: affecting the blood supply of the brain; (5) nerve root injury: the corresponding signs in the innervation area; (6) a slow progressive scapula and internal atrophy of the upper and hand muscles. The atlantoaxial instability has a serious risk, and it is easy to cause the upper cervical spinal cord, nerve root, and vertebral artery compression. The shape and signs can cause paralysis of the extremities and even endanger life. Therefore, surgical treatment is often needed. The atlantoaxial instability is divided into the posterior and anterior internal fixation. The posterior operation mainly includes the atlantoaxial laminectomy wire technique, the laminar clamp technique, the Magerl joint screw technique, and the posterior atlantoaxial pedicle screw rod technique. The technical biomechanics of the atlantoaxial interlaminar steel wire used in the early middle period is poor, the posterior arch of the atlas is complete, and the fixation is unreliable. The mechanical properties of the Magerl joint screw technique and the posterior atlantoaxial pedicle screw rod system of the atlas are improved, and the fixation is reliable, but the iatrogenic nature of the congenital posterior lateral bone structure of the upper cervical spine is iatrogenic. Posterior approach is difficult to perform. Posterior approach is difficult to perform. Anterior approach is difficult to perform. At the same time, posterior surgery is not capable of compression or adhesion from the front of the spinal cord. Anterior decompression or release is required. One or two phases of the posterior approach are fixed, and the intraoperative turn over may cause a fatal ridge. Spinal cord injury, which also increases the cost of hospitalization. Anterior surgery was used mainly in patients with posterior atlantoaxial loss of bone structure or abnormal vertebral artery, which were not suitable for posterior surgical treatment. However, after recent development, it has been used for various atlantoaxial instability and has the advantages of no posterior operation. Atlas and atlantoaxial titanium plate fixation can be used for anterior lateral release and decompression, and it has been widely used in fresh and old traumatic atlantoaxial instability and has achieved a certain effect. But the fatal insufficiency is that the operation is operated under the condition of contamination and susceptible to infection, and once the dural membrane is damaged in the operation, the cerebrospinal fluid is caused. The infection will be difficult to control or even endanger life. Therefore, the submandibular approach is a new choice for anterior surgery, but there is no satisfactory internal fixator. For example, the internal fixation of the atlantoaxial lateral mass of the axis, which requires a larger obliquity, easily damages the spinal cord and vertebral artery, and requires a higher integrity of the axis of the axis. The anterior approach of the vertebral anterior approach through the internal fixation of the articular screw and the anterior internal direction of the axis and the lateral mass of the atlas can avoid intraspinal spinal cord injury and reduce the risk of injury to the spinal cord or the vertebral artery. The atlantoaxial anterior transarticular screw internal fixation has been popularized in our hospital and has achieved satisfactory results. However, the biomechanical properties of the technology need to be further improved, and the requirements for the anterior side of the axis are high. If the screws are loose, the screws are easy to loose and release, and the operation is difficult. The atlantoaxial joint locking titanium plate screw internal fixation system is the independent knowledge production we have developed. The right atlantoaxial anterior internal fixation system (patent number: ZL 20112 0134687.X), the system has the function of reduction and locking, using submandibular surgical approach, anterior loosening and decompression at the same time for internal fixation, simplifying the operation and enhancing the reliability of internal fixation. This subject is to observe the internal fixation system by establishing the operation model of the system. The degree of anastomosis with the atlantoaxial complex was made to determine the three-dimensional stability and safety of the unstable atlantoaxial fixation by the anterior flexion, extension, left and right lateral bending and the direction of rotation in the anterior approach of the atlantoaxial joint, which was fixed by the atlantoaxial joint locking titanium plate and screw. The application of plate screw internal fixation provides a theoretical basis for clinical application. Part 1 the three-dimensional stability of the anterior atlantoaxial locking titanium plate screw internal fixation system aims to evaluate the anterior atlantoaxial joint by mechanical experiments on the fresh cervical vertebra cadaver specimens. The three-dimensional stability of atlantoaxial instability was treated with locking titanium plate and screw fixation, thus providing a biomechanical basis for the clinical application of the internal fixation. Methods 8 fresh adult male cervical specimens, excluding all cervical diseases, were removed from the cervical spine, and the cervical muscles were removed and the intact ligaments and joint sacs were retained. The experimental specimens of the complete state of the occipital bone to the cervical 4 vertebral body (C0 ~ C4) were embedded with polymethyl methacrylate (denture powder), buried above the C0, and buried below the C4, and stored in the refrigerator of -20 C for preservation of the spare.8 specimens, respectively, for the complete state of each specimen, the odontoid type II fracture, and the anterior approach locking the titanium plate through the atlantoaxial joint. Measurement of three-dimensional motion range under four states of fixation and posterior atlantoaxial pedicle screw fixation. Each specimen is measured in a three-dimensional motion under normal condition, and then the specimen causes atlantoaxial instability (odontoid type II fracture), and the specimen is measured in the three-dimensional motion of the odontoid type II fracture. The anterior atlantoaxial locking titanium plate screw fixation and posterior atlantoaxial pedicle screw fixation were performed respectively, and the three-dimensional motion range was measured in different states. In order to eliminate the effect of the same specimen on the experimental results due to the order of fixation, the sequence of anterior and posterior fixation was carried out randomly. The biomechanical test specimens were carried out. The three-dimensional motion test is carried out on the spine three-dimensional motion test machine Spine2000 (accuracy 0.01Nm) under non destructive mode. After the specimen is fixed, the pure couple moment of 2.0Nm is applied. By loading the specimen and unloading the load 2.0Nm, the 6 motion directions, such as the forward flexion, the extension, the left side bend, the right bend and left, right rotation, are measured. Each direction is loaded 3 times, the first 2 times to eliminate the effect of creep, and the third time to accurately measure the angular displacement of each motion direction as the reference value, so as to determine the range of motion of the specimen (range of motion, ROM). The normal, odontoid type II fracture, the anterior approach through the atlantoaxial locking titanium plate screw fixation and the posterior atlantoaxial pedicle screw fixation, the anterior atlantoaxial locking titanium plate screw fixation and the posterior atlantoaxial pedicle screw fixation of the atlantoaxial motion are less than normal and odontoid type II fractures in the anterior approach of ROM.. There was a significant difference between the anterior flexion, extension, lateral bending and left and right rotation of the atlas and axis in the odontoid type II fracture group (P0.000). There was no significant difference between the three dimensions of the atlantoaxial three dimension movement in the anterior atlantoaxial locking titanium plate screw fixation and the posterior atlantoaxial pedicle screw fixation (anterior flexion P=0.930, later). P=0.952, left and right P=0.947, left and right rotation P=0.950). The anterior approach through the atlantoaxial locking titanium plate screw fixation and posterior atlantoaxial pedicle screw fixation in the anterior flexion, extension, left and right side bending and left and right rotation of the stability index of ROM were not significant (P0.05), the two of the three dimensional stability was better. But the anterior path through the atlantoaxial joint locking titanium plate screw The three-dimensional motion range of the atlantoaxial motion is slightly larger than that of the posterior atlantoaxial pedicle screw. Conclusion the three-dimensional motion range of the atlantoaxial motion in the anterior atlantoaxial locking titanium plate and screw is significantly smaller than that of the normal and odontoid type II fractures (P0.000), and the three-dimensional motion range of the atlantoaxial motion fixed with the posterior pedicle screw is not statistically significant. The range of anterior flexion movement after the atlantoaxial locking titanium plate screw internal fixation is (1.39 + 0.26). The extension movement range is (1.40 + 0.22). The range of lateral bending is (1.43 + 0.23). The range of rotation is (1.77 + 0.34). It can instantly stabilize the atlantoaxial complex and obviously reduce the range of movement in all directions of the atlantoaxial joint. It is good. Good biomechanical properties. The anatomical safety of the second part of the anterior atlantoaxial locking titanium plate screw internal fixation system objective to evaluate the internal fixation through the atlantoaxial locking titanium plate screw fixation on the front of the new cervical spine instability standard and to analyze the anatomical data obtained after the CT three-dimensional reconstruction and evaluate the internal fixation. Methods the anatomical safety of the system in clinical application. Methods 8 fresh adult male cervical specimens with accidental death were treated with anterior atlantoaxial locking titanium plate and screw internal fixation (prior to the procedure), and the 8 surgical models were scanned with 2.0mm layer thickness by multi-slice spiral CT (MSCT). The original number would be obtained. The images of multi plane reconstruction (MPR) and volume reconstruction (VR) and multiplane reconstruction (MPR) were reported to the Vitrea 2 workstation. The distance between the atlantoaxial screw and the vertebral artery and spinal cord on the different planes, the distance to the articular surface of the lateral mass of the atlas, and the numbers were measured at the same time. The images after the multiplane reconstruction (MPR) were measured by the Vitrea 2 workstation. The anatomical safety of the clinical application of the anterior atlantoaxial locking titanium plate screw internal fixation system was analyzed by chemical photography (DR). Results the X-ray examination of the anterior approach after the atlantoaxial locking titanium plate screw internal fixation showed that the locking titanium plate was in good agreement with the axis, and the screws were all inside the bone and did not enter the spinal canal and the transverse process. The multi-slice spiral CT (MSCT) scan was not used. The results showed that the cross section A (the upper margin of the transverse process of the atlas) was (5.35 + 1.02) mm and (8.55 + 0.93) mm through the atlantoaxial screw (vertebral canal wall) and the spinal cord (the medial wall of the transverse foramen), and the distance between the lateral mass of the atlas and the lateral mass of the atlas was (3.45 + 0.64) mm, and the distance between the screws of the transverse section of the transverse section of the atlas and the vertebral artery and the spinal cord was divided. The distance between (5.55 + 0.99) mm and (8.15 + 1.03) mm. cross section C (lower axis of the upper articular surface of the axis) and the distance between the vertebral artery and the spinal cord were (9.75 + 1.21) mm and (10.95 + 1.02) mm.. The anterior atlantoaxial locking titanium plate screw internal fixation system could instantly stabilize the atlantoaxial complex, and there was sufficient space for nailing in the atlantoaxial bone without injury. The anterior atlantoaxial locking titanium plate screw fixation system is anatomically safe and feasible, so the anterior atlantoaxial locking titanium plate screw internal fixation system is safe for clinical application.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.4

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