本文選題：寰樞椎　切入點：內(nèi)固定　出處：《第二軍醫(yī)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的設(shè)計一種基于寰樞椎傳統(tǒng)釘棒基礎(chǔ)上的寰樞椎U型棒鈦纜內(nèi)固定技術(shù),并通過影像學(xué)研究和離體人體標(biāo)本的生物力學(xué)研究,評估其安全性及生物力學(xué)穩(wěn)定性。研究方法1、獲取從2016年6月至2016年8月門診和病房所攝50例成年人(男女各25例)患者的頸椎CT薄層掃描及三維重建圖像,利用Philips IntelliSpace Portal系統(tǒng)測定C1椎弓根的尺寸,包括高度和寬度,設(shè)計C1椎弓根螺釘?shù)睦硐脶數(shù)?確定理想的進釘點及內(nèi)傾角。2、選取6具新鮮成人的枕頸部標(biāo)本(C0 3)節(jié)段,通過實驗機器對其施加1.5Nm的純力偶矩,產(chǎn)生前后屈伸、左右側(cè)屈、軸向旋轉(zhuǎn)六個方向的純力偶矩,每次實驗測試時加載3個循環(huán),每次循環(huán)持續(xù)10秒,并按照以下實驗順序記錄第3次循環(huán)的前屈后伸、左右側(cè)屈、左右旋轉(zhuǎn)6個方向上的三維運動范圍(ROM):完整組(M1組)、Gallie組(M3組)、Bilateral cable組(M4組)、Unilateral cable組(M5組)、雙側(cè)PS組(M6組)、失穩(wěn)組(M2組)。結(jié)果1、評價寰椎椎弓根螺釘相關(guān)測量數(shù)據(jù)的左側(cè)和右側(cè)之間沒有統(tǒng)計學(xué)上的顯著性差異(P0.05),在男性和女性之間的許多參數(shù)中存在統(tǒng)計學(xué)差異(P0.05),而兩者的釘?shù)纼?nèi)傾角,女性大于男性,但沒有統(tǒng)計學(xué)差異(P0.05)(表1 3)。椎弓根高度4.0mm螺釘直徑的比例為23%(23/100),而3.5mm螺釘直徑的比例達到13.0%(13/100)。理想寰椎椎弓根螺釘釘?shù)赖倪M釘點與矢狀面的垂直距離,男性為19.93±1.32mm,女性為18.01±1.24mm,螺釘?shù)膬?nèi)傾角度,男性為7.07±2.19°,女性為7.20±1.65°,釘?shù)篱L度,男性為28.52±1.70mm,女性為27.74±1.96mm。2、6具標(biāo)本的失穩(wěn)組較完整組均表現(xiàn)出明顯活動度增加,所有標(biāo)本分別加載4種不同內(nèi)固定組合后,寰樞椎在不同工況下的活動度均有不同程度的顯著性減少,穩(wěn)定性增加。Unilateral cable組與其它內(nèi)固定組ROM相比,在各個方向上均有所減少,特別是在左右側(cè)屈及軸向旋轉(zhuǎn)方向上有顯著性差異。結(jié)論1、寰椎椎弓根螺釘置釘?shù)陌踩灾饕Q于椎動脈溝下方椎弓根的外壁高度和髓腔高度,通過患者術(shù)前的CT薄層掃描及三維重建片,評估寰椎椎弓根置釘?shù)陌踩灾陵P(guān)重要,對于外壁高度3.5mm的患者應(yīng)謹(jǐn)慎置釘,而對于無髓腔的患者避免選擇椎弓根螺釘,而應(yīng)選擇替代方案。2、寰樞椎U型棒鈦纜內(nèi)固定系統(tǒng)手術(shù)操作簡單、安全,穩(wěn)定性好,可以作為寰樞椎椎弓根螺釘固定技術(shù)的替代方案和補救術(shù)式,從而有效治療寰樞椎脫位,特別是難復(fù)性脫位。
[Abstract]:Objective to design an atlantoaxial U-bar titanium cable internal fixation technique based on the traditional atlantoaxial screw rod, and to study the biomechanics of human specimens by imaging and in vitro. Methods 1. From June 2016 to August 2016, 50 adult patients (25 males and 25 males) were examined with thin slice CT and 3D reconstruction images of cervical vertebrae. The size of C1 pedicle, including height and width, was measured by Philips IntelliSpace Portal system. The ideal nail passage of C1 pedicle screw was designed. The ideal point of entry and the angle of inclination were determined. The occipitocervical specimens of 6 fresh adults were selected. The pure force couple moment of 1.5 Nm is applied to it by the experimental machine, which produces the pure force couple moment in six directions of flexion and extension, left and right flexion, axial rotation. Three cycles are loaded in each experiment, and each cycle lasts 10 seconds. According to the following experimental sequence, the third cycle of forward flexion and extension, left and right flexion, The range of three dimensional motion in 6 directions of left and right rotation: complete group M 1, group M 3, cable group M 3, group M 4, group M 5, bilateral cable group M 5, bilateral PS group M 6, and unstable group M 2. Results 1. To evaluate the relevant measurement data of atlas pedicle screws. There was no statistically significant difference between the side and the right side (P 0.05). There was a statistical difference in many parameters between men and women (P 0.05). Women are larger than men, but there is no statistical difference (Table 13). The ratio of pedicle height 4.0mm screw diameter is 2323 / 100m, while 3.5mm screw diameter is 13.0mm / 1000.The ideal vertical distance between the point of entry and sagittal plane of the nail path of atlas pedicle screw is ideal. The angle of introversion of screw was 7.07 鹵2.19 擄in male and 7.20 鹵1.65 擄in female. The length of nail canal was 28.52 鹵1.70 mm in male and 27.74 鹵1.96 mm 路2mm in female. After all the specimens were loaded with four different internal fixation combinations, the motion of atlantoaxial vertebrae decreased significantly in different working conditions, and the stability increased. Compared with other internal fixation groups, ROM decreased in all directions in the cable group. Conclusion 1. The safety of atlas pedicle screw placement mainly depends on the height of the external wall and the medullary cavity of the pedicle below the vertebral artery sulcus. It is very important to evaluate the safety of atlas pedicle screw placement by CT thin slice scan and 3D reconstruction before operation. The patients with 3.5mm height of external wall should be careful with screw placement, while patients with unmyelinated cavity should avoid the choice of pedicle screw. It is suggested that the alternative should be .2. the internal fixation system of atlantoaxial U-bar titanium cable is simple, safe and stable. It can be used as an alternative and a remedy for atlantoaxial pedicle screw fixation, so as to effectively treat atlantoaxial dislocation. In particular, the dislocation is difficult to be refolded.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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