【摘要】：枕寰樞復(fù)合體位于生命中樞相對(duì)應(yīng)的部位,具有獨(dú)特及復(fù)雜的解剖結(jié)構(gòu)和功能。各種先天性或獲得性因素致其局部骨質(zhì)和韌帶結(jié)構(gòu)破壞所引起的枕頸部不穩(wěn),易導(dǎo)致延髓、高位脊髓壓迫,潛在危險(xiǎn)性大,往往需行枕頸融合內(nèi)固定術(shù)。由于寰、樞椎及枕骨髁處于顱頸連接區(qū)域,解剖位置深、結(jié)構(gòu)復(fù)雜,與延髓、脊髓、椎動(dòng)脈、咽喉、氣管、食管、頸部大血管及喉上神經(jīng)、舌下神經(jīng)等重要結(jié)構(gòu)關(guān)系緊密,被視為外科手術(shù)的危險(xiǎn)區(qū)域。后路手術(shù)以其顯露容易、易于安置內(nèi)固定器械而受到臨床推崇。但對(duì)于臨床上后路手術(shù)實(shí)施困難或無法實(shí)施的病例,前路手術(shù)成為一種相對(duì)理想的選擇。目前,前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定已有個(gè)案報(bào)道,但因單用螺釘固定力學(xué)性能不高,進(jìn)釘方向不易把握且對(duì)樞椎椎體前側(cè)骨性結(jié)構(gòu)要求高,臨床上未能普及。有鑒于此,我科自行研制了一套前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘系統(tǒng)。 本研究通過對(duì)前路經(jīng)關(guān)節(jié)解剖鎖定鋼板螺釘內(nèi)固定術(shù)進(jìn)行相關(guān)的臨床解剖學(xué)研究,設(shè)計(jì)出適合國(guó)人的鎖定解剖鈦板及其安裝器械系列。鎖定解剖鈦板用于頜下手術(shù)入路,其兼有鎖定與瞄準(zhǔn)器功能,可簡(jiǎn)化手術(shù)操作,增強(qiáng)內(nèi)固定的穩(wěn)定性。通過對(duì)其相關(guān)的基礎(chǔ)研究,評(píng)估其臨床應(yīng)用的可行性及安全性,將為治療創(chuàng)傷性枕頸部不穩(wěn)定患者提供一種具有自主知識(shí)產(chǎn)權(quán)的新型內(nèi)固定技術(shù)與器械,可提高枕頸不穩(wěn)定患者的救治成功率,減輕病人的痛苦及社會(huì)負(fù)擔(dān),具有極大的軍事及社會(huì)效益。 研究目的 1、通過測(cè)量前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的相關(guān)解剖學(xué)參數(shù),評(píng)估國(guó)人前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的可行性,為其臨床應(yīng)用提供解剖學(xué)依據(jù)； 2、通過測(cè)量前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的釘?shù)绤?shù)及釘?shù)琅c椎動(dòng)脈的距離,評(píng)估前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的安全性； 3、通過對(duì)前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的相關(guān)解剖學(xué)參數(shù)進(jìn)行測(cè)量,為此種內(nèi)固定系統(tǒng)的設(shè)計(jì)提供解剖學(xué)依據(jù)；4、通過模擬內(nèi)固定手術(shù),驗(yàn)證前路經(jīng)寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù)內(nèi)固定螺釘?shù)目尚行耘c安全性,為其臨床應(yīng)用提供實(shí)驗(yàn)依據(jù)。 實(shí)驗(yàn)一干燥枕寰樞配套標(biāo)本的解剖學(xué)測(cè)量 目的通過測(cè)量國(guó)人前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的相關(guān)解剖學(xué)參數(shù),評(píng)估前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的可行性,為其臨床應(yīng)用提供解剖學(xué)依據(jù)。 方法取30具國(guó)人干燥枕頸部標(biāo)本,觀察枕寰樞骨性結(jié)構(gòu)的解剖學(xué)形態(tài)特點(diǎn)；測(cè)量與前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)相關(guān)的解剖徑線：枕骨髁關(guān)節(jié)面前后徑及左右徑,舌下神經(jīng)管與枕骨髁關(guān)節(jié)面間距,枕骨髁后緣1/3高度,寰椎上關(guān)節(jié)面前后徑與左右徑,寰椎側(cè)塊內(nèi)緣及外緣高度,樞椎上關(guān)節(jié)面前后徑與左右徑,樞椎椎體左右徑與上下徑；經(jīng)關(guān)節(jié)螺釘釘?shù)绤?shù)：螺釘植入最大外傾角,最小外傾角,理想外傾角,最大后傾角,理想后傾角,內(nèi)側(cè)釘?shù)篱L(zhǎng)度,外側(cè)釘?shù)篱L(zhǎng)度,理想釘?shù)篱L(zhǎng)度；椎體固定螺釘釘?shù)绤?shù)：螺釘植入理想內(nèi)傾角,理想上傾角,理想釘?shù)篱L(zhǎng)度。 結(jié)果枕寰樞骨性結(jié)構(gòu)的解剖學(xué)形態(tài)特點(diǎn):(1)樞椎前弓下緣與樞椎椎體側(cè)緣交界點(diǎn)上方約4mm有一恒定存在的骨性凹陷,骨性標(biāo)志明確；(2)舌下神經(jīng)管是位于枕骨髁關(guān)節(jié)面上方的骨性管道,管道自內(nèi)后向前外上方走行。舌下神經(jīng)管位于枕骨髁前2/3者51例(85%),枕骨髁后1/3者9例(15%)；(3)寰椎側(cè)塊外厚內(nèi)薄,其外緣高度約為內(nèi)緣高度的2倍；其上關(guān)節(jié)面呈腎形凹面,中部狹窄,下關(guān)節(jié)面內(nèi)緣較上關(guān)節(jié)面內(nèi)緣更靠近矢狀面；(4)枕骨髁關(guān)節(jié)面呈舟狀凸面,中部較前后緣厚,其中1例枕骨髁呈啞鈴狀(1.67%)；同時(shí)大部分標(biāo)本枕髁后方有一髁窩,出現(xiàn)率為47例(78.33%)；(5)樞椎椎體前表面中部為一“鼻狀”突起；(6)樞椎椎體前下緣形成“舌狀”突出,使椎體下表面呈“穹窿狀”。前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)相關(guān)的解剖徑線及釘?shù)绤?shù)：經(jīng)關(guān)節(jié)螺釘入釘點(diǎn)間距(15.25±0.94)mm；在矢狀面上螺釘植入的最小外傾角為(10.23±0.63)°,最大外傾角為(27.73±2.67)°,理想外傾角為(18.75±1.70)°；冠狀面上最大后傾角為(31.72±2.59)°,理想后傾角(24.40±2.11)°；內(nèi)、外側(cè)釘?shù)篱L(zhǎng)度分別為(32.98±1.68)mm、(36.54±2.01)mm；理想釘?shù)篱L(zhǎng)度(34.45±1.95)mm。 結(jié)論前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)在解剖上是可行的。 實(shí)驗(yàn)二前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定的CTA測(cè)量及其臨床意義 目的：通過對(duì)頭頸部CTA檢查的影像資料行前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定術(shù)的相關(guān)釘?shù)绤?shù)及釘?shù)琅c椎動(dòng)脈的距離進(jìn)行測(cè)量,評(píng)估此種內(nèi)固定術(shù)的安全性。 研究對(duì)象：從我院頭頸部CTA檢查的影像資料中隨機(jī)選取30例,其中男18例,女12例；年齡21～55歲,平均33.6±4.2歲。納入標(biāo)準(zhǔn)：①年齡20-60歲；②檢查時(shí)間為從2010年10月01至2011年04月01日。排除標(biāo)準(zhǔn)：①發(fā)育畸形及解剖變異；②骨質(zhì)破壞(含腫瘤、炎癥或骨折等)；③既往頸椎病病史；④既往頸椎手術(shù)史。 方法：將納入本研究的30例CTA檢查原始掃描數(shù)據(jù)傳入Vitreal4.0工作站,通過容積顯示(VR)、多平面重建(MPR)等技術(shù)進(jìn)行圖像處理。在重建圖像上觀察枕寰樞骨性結(jié)構(gòu)及釘?shù)榔矫孀祫?dòng)脈的形態(tài)特點(diǎn)。觀察樞椎椎體前表面的解剖學(xué)特征,尋求螺釘入釘點(diǎn)解剖標(biāo)志；觀察舌下神經(jīng)管與枕骨髁的相對(duì)位置,確定螺釘安全的錨定點(diǎn)；觀察上頸椎椎動(dòng)脈的走行特點(diǎn);利用Vitreal軟件測(cè)量經(jīng)關(guān)節(jié)螺釘理想釘?shù)澜嵌扰c長(zhǎng)度和椎體固定螺釘釘?shù)澜嵌扰c長(zhǎng)度。測(cè)量入釘點(diǎn)平面兩側(cè)椎動(dòng)脈間距及不同層面上釘?shù)琅c椎動(dòng)脈的距離。 結(jié)果：椎動(dòng)脈于入釘點(diǎn)平面至錨定點(diǎn)平面在形態(tài)上有5個(gè)恒定的彎曲,其中第1、3彎曲處椎動(dòng)脈更加靠近正中矢狀面,經(jīng)關(guān)節(jié)螺釘入釘點(diǎn)平面處兩側(cè)椎動(dòng)脈間距為(25.59±1.04)mm。經(jīng)關(guān)節(jié)螺釘釘?shù)绤?shù)：入釘點(diǎn)間距(15.25±0.94)mm,理想外傾角(18.75±1.70)mm,理想后傾角(24.40±2.11)mm。椎體固定螺釘釘?shù)绤?shù)：入釘點(diǎn)間距(9.21±0.72)mm,理想內(nèi)傾角(13.89±0.87)mm,理想上傾角(17.21±1.14)mm。經(jīng)關(guān)節(jié)螺釘理想釘?shù)琅c椎動(dòng)脈的關(guān)系于寰椎橫突孔上方椎動(dòng)脈彎曲平面最為密切,其距離為(3.6±0.71)mm。 結(jié)論：國(guó)人采用前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定在解剖上是可行的,釘?shù)琅c椎動(dòng)脈之間有一定的安全距離,但術(shù)中必須嚴(yán)格控制釘?shù)婪较颉Ｐg(shù)前通過螺旋CTA三維重建片進(jìn)行個(gè)體化術(shù)前設(shè)計(jì),可以模擬前路經(jīng)枕寰樞關(guān)節(jié)鎖定鈦板螺釘內(nèi)固定的釘?shù)儡壽E、釘?shù)赖睦硐虢嵌群烷L(zhǎng)度,有效地避免釘?shù)缹?duì)椎動(dòng)脈的損傷,有助于提高患者的安全性。 實(shí)驗(yàn)三模擬前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù)的實(shí)驗(yàn)研究 目的：通過模擬前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù),探討前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定的可行性與安全性,為其臨床應(yīng)用提供實(shí)驗(yàn)依據(jù)。 方法：對(duì)國(guó)人枕頸部干燥配套標(biāo)本及福爾馬林常規(guī)防腐標(biāo)本行CT三維重建檢查,并進(jìn)行個(gè)體化術(shù)前設(shè)計(jì)。依據(jù)術(shù)前測(cè)量的個(gè)體化參數(shù)在標(biāo)本上模擬前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù)。首先顯露骨性標(biāo)志,確定入釘點(diǎn),選擇枕骨髁長(zhǎng)軸的中后1/3為理想錨定點(diǎn),分別應(yīng)用1.0mm克氏針按術(shù)前測(cè)量的理想釘?shù)澜嵌仍谕庵脤?dǎo)向器輔助下向外、后、上方鉆入,邊進(jìn)針邊透視,整個(gè)操作過程在C臂X光機(jī)透視監(jiān)測(cè)下進(jìn)行,透視見克氏針方向、長(zhǎng)度滿意后用2.7mm空心電鉆沿克氏針鉆入,依次穿過寰樞關(guān)節(jié)及寰枕關(guān)節(jié)進(jìn)入枕骨髁,至枕骨髁上方皮質(zhì)下停止。測(cè)深并選擇合適長(zhǎng)度的4.0mmAO鈦質(zhì)空心螺釘擰入。標(biāo)本固定后行X線及CT檢查以驗(yàn)證螺釘位置,運(yùn)用計(jì)算機(jī)軟件測(cè)量實(shí)際釘?shù)赖慕嵌�、長(zhǎng)度。 結(jié)果：枕頸部標(biāo)本模擬前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù)后可獲得即刻穩(wěn)定,術(shù)后影像學(xué)檢查證實(shí)螺釘經(jīng)過寰枕關(guān)節(jié)及寰樞關(guān)節(jié),均位于骨性結(jié)構(gòu)內(nèi),無穿出骨質(zhì)者；螺釘均未損傷舌下神經(jīng)管。利用CT白帶的Vitreal計(jì)算機(jī)軟件測(cè)量實(shí)際釘?shù)绤?shù)(外傾角、后傾角、長(zhǎng)度)均位于其參考值的范圍之內(nèi)。 結(jié)論：國(guó)人采用前路經(jīng)枕寰樞關(guān)節(jié)螺釘內(nèi)固定在解剖上是可行的。但應(yīng)注意其對(duì)釘?shù)赖臏?zhǔn)確性要求較高,臨床上為增加手術(shù)的安全性,恢復(fù)患者枕頸部結(jié)構(gòu)的正常解剖關(guān)系是應(yīng)用此種內(nèi)固定術(shù)的前提。
[Abstract]:Occipito-atlanto-occipital complex has unique and complex anatomical structures and functions in the corresponding parts of the life center. Occipito-cervical instability caused by various congenital or acquired factors may easily lead to the medulla oblongata, compression of the high spinal cord, and potentially dangerous. Occipito-cervical fusion and internal fixation are often required. The atlas, axis and occipital condyle are located in the craniocervical junction area, with deep anatomical position and complex structure. They are closely related to the medulla oblongata, spinal cord, vertebral artery, pharynx, larynx, trachea, esophagus, cervical blood vessels, superior laryngeal nerve, hypoglossal nerve and other important structures, and are considered as dangerous areas for surgical operations. Posterior approach surgery is easy to expose and easy to place internal fixation instruments. Anterior transoccipito-atlantoaxial screw fixation has been reported in some cases, but because of its poor mechanical properties, the direction of screw insertion is difficult to grasp and the anterior osseous structure of the axial vertebral body is important. In view of this, our department has developed a set of anterior transoccipito-atlantoaxial locking titanium plate screw system.
In this study, we designed a series of locking anatomical titanium plates and their installing instruments suitable for Chinese through clinical anatomical study of anterior transarticular locking plate and screw fixation. Locked anatomical titanium plates are used for submandibular surgery, which have the function of locking and sighting devices. They can simplify the operation and enhance the stability of internal fixation. To evaluate the feasibility and safety of its clinical application through the relevant basic research will provide a new type of internal fixation technology and equipment with independent intellectual property rights for the treatment of traumatic occipitocervical instability, which can improve the success rate of treatment of patients with occipitocervical instability, alleviate the pain and social burden of patients with great. Military and social benefits.
research objective
1. To evaluate the feasibility of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipital atlantoaxial locking titanium plate screw fixation, and to provide anatomical basis for its clinical application.
2. To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation, the parameters of screw path and the distance between screw path and vertebral artery were measured.
3. To provide anatomical basis for the design of the anterior transatlantoaxial locking titanium plate screw fixation system by measuring the related anatomical parameters; 4. To verify the feasibility and safety of the anterior transatlantoaxial screw fixation by simulating the operation. Experimental basis.
Anatomic measurement of dried occipital atlantoaxial matching specimens
Objective To evaluate the feasibility of anterior transoccipito-atlantoaxial locking titanium plate screw fixation by measuring the anatomical parameters of anterior transoccipito-atlantoaxial locking titanium plate screw fixation.
Methods 30 dry occipital and cervical specimens of Chinese were taken to observe the anatomical features of occipital and atlantoaxial bony structures, and the anatomical diameters related to anterior transoccipital atlantoaxial locking titanium plate screw fixation were measured: the anterior and posterior diameters of occipital condylar joint, the distance between hypoglossal nerve canal and occipital condylar joint, the height of occipital condyle posterior margin 1/3, the height of atlas. Anterior and posterior diameters and left and right diameters of the upper joints, height of the inner and outer edges of the lateral mass of the atlas, anterior and posterior diameters and left and right diameters of the upper joints, left and right diameters and upper and lower diameters of the axis; parameters of the trans-articular screw path: maximum extroversion angle, minimum extroversion angle, ideal extroversion angle, maximum posteversion angle, ideal posterior inclination angle, medial screw path length, lateral screw path Length, ideal screw path length; Vertebral fixation screw path parameters: ideal inclination angle, ideal inclination angle, ideal screw path length.
Results The anatomical and morphological characteristics of occipito-atlantoaxial bony structure were as follows: (1) There was a constant osseous depression about 4 mm above the junction of anterior arc of axis and lateral margin of axis, and the osseous markers were clear; (2) The hypoglossal canal was a osseous canal located above the occipital condyle joint, and the canal ran from inside to outside. 51 cases (85%) had anterior 2/3 of the condyle, 9 cases (15%) had posterior 1/3 of the occipital condyle; (3) the lateral mass of the atlas was thick and thin, and the height of its outer edge was about twice the height of the inner edge; the upper joint surface was kidney-shaped concave, the middle was narrow, and the inner edge of the inferior joint surface was closer to the sagittal surface than the inner edge of the upper joint surface; (4) the occipital condyle surface was scaphoid, and the middle was thicker than the anterior and posterior edge, of which 1. The occipital condyle was dumbbell-shaped (1.67%) in most cases, and there was a condylar fossa behind the occipital condyle in 47 cases (78.33%); (5) the middle part of the anterior surface of the axis was a "nose-like" protrusion; (6) the anterior and inferior edge of the axis formed a "tongue-like" protrusion, which made the subsurface of the vertebral body "fornix-like". Anterior fixation with titanium plate screw locked through the occipito-atlanto-axial joint. The anatomical diameter and the parameters of the screw canal were as follows: the distance between the insertion points was (15.25 (+ 0.94) mm; the minimum extroversion angle was (10.23 (+) 0.63)degrees, the maximum extroversion angle was (27.73 (+) 2.67)degrees, the ideal extroversion angle was (18.75 (+) 1.70)degrees; the maximum retroversion angle was (31.72 (+) 2.59)degrees and the ideal retroversion angle was (24.40 (+) 2.1). The length of internal and external nail canals were (32.98 (+ 1.68) mm, (36.54 (+ 2.01) mm, and the ideal nail canal length was (34.45 (+ 1.95) mm.
Conclusion anterior locking titanium plate fixation via occipital atlantoaxial joint is feasible in anatomy.
Experiment two CTA measurement of anterior atlantoaxial locking titanium plate fixation and its clinical significance
Objective: To evaluate the safety of anterior transoccipital atlantoaxial locking titanium plate screw fixation by measuring the parameters of screw path and the distance between screw path and vertebral artery.
Participants: Thirty patients, 18 males and 12 females, aged 21-55 years with an average of 33.6 (+ 4.2 years) were randomly selected from the CT images of head and neck in our hospital. A history of cervical spondylosis; a history of previous cervical surgery.
Methods: The original CT scan data of 30 cases were transferred to Vitreal 4.0 workstation and processed by volume rendering (VR) and multiplanar reconstruction (MPR). Anatomical markers of screw insertion points; relative positions of hypoglossal canal and occipital condyle were observed to determine the safe anchoring point of screw; the course characteristics of superior cervical vertebral artery were observed; the ideal angle and length of screw path and the angle and length of screw path were measured by Vitreal software; and the intervertebral arteries were measured on both sides of the plane of screw insertion points. The distance between nail path and vertebral artery at different levels.
Results: There were five constant curvatures of vertebral artery from the plane of screw entry point to the plane of anchorage point. The first and third curvatures of vertebral artery were closer to the median sagittal plane. The interval between vertebral artery and vertebral artery at the plane of screw entry point was (25.59 (1.04) mm. The ideal posterior inclination angle was (24.40 (+ 2.11) m M. The parameters of the screw canal were (9.21 (+ 0.72) m m at the entry point, 13.89 (+ 0.87) m m at the ideal inclination angle, 17.21 (+ 1.14) m M. The relationship between the ideal screw canal and the vertebral artery was the closest at the curvature plane of the vertebral artery above the transverse foramen of the atlas, and the distance was (3.6 (+ 0.71) M. M.
Conclusion: Anterior transoccipito-atlantoaxial locking titanium plate screw fixation is anatomically feasible in Chinese. There is a safe distance between the screw canal and vertebral artery, but the direction of the screw canal must be strictly controlled during operation. The trajectory of the screw path, the ideal angle and length of the screw path can effectively avoid the injury of the vertebral artery and improve the safety of the patients.
Experiment three experimental study of anterior atlantoaxial screw fixation via simulated anterior approach
Objective: To investigate the feasibility and safety of anterior transoccipital atlantoaxial screw fixation by simulating anterior transoccipital atlantoaxial screw fixation, and to provide experimental basis for its clinical application.
Methods: Three-dimensional CT reconstructions were performed on Chinese dry occipitocervical specimens and formalin preserved specimens, and individualized preoperative design was carried out. The latter 1/3 is the ideal anchoring point, respectively, using 1.0 mm Kirschner wire according to the preoperative measurement of the ideal angle of the nail path outside under the assistance of external guide, after drilling in the upper part, while the needle fluoroscopy, the entire operation process under the C-arm X-ray machine perspective monitoring, fluoroscopy Kirschner needle direction, the length of satisfaction with the 2.7 mm hollow electric drill along the Kirschner needle drilling, in turn through. Transatlanto-axial and atlanto-occipital joints entered the occipital condyle and stopped below the cortex above the occipital condyle. The appropriate length of 4.0 mm AO titanium hollow screw was selected and screwed in. The specimens were fixed and examined by X-ray and CT to verify the screw position. The angle and length of the actual screw canal were measured by computer software.
Results: The occipitocervical specimens were stabilized immediately after simulated anterior transoccipito-atlantoaxial screw fixation. Imaging examination showed that the screw was located in the osseous structure and did not penetrate the osseous structure. The hypoglossal nerve canal was not damaged by the screw. The path parameters (camber, dip angle and length) are all within the scope of their reference values.
Conclusion: Anterior trans-occipito-atlantoaxial screw fixation is anatomically feasible in Chinese, but the accuracy of the screw canal should be paid attention to. In order to increase the safety of the operation, restoring the normal anatomical relationship of the occipito-cervical structure is the premise of this kind of internal fixation.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R322.7;R687.4

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