本文選題：數(shù)字化 + 枕骨髁　； 參考：《中國脊柱脊髓雜志》2017年07期

【摘要】：目的:利用數(shù)字化三維重建技術(shù)測量枕骨髁螺釘?shù)淖罴阎冕攨?shù),探討后路枕骨髁螺釘置入的安全性及各置釘參數(shù)間的相關(guān)性。方法:選取50例枕頸部形態(tài)正常者的上頸椎螺旋CT掃描圖像,男25例,女25例,年齡25~60歲(38.5±7.6歲)。排除骨折脫位、感染、腫瘤、畸形及退行性變,將數(shù)據(jù)導(dǎo)入Mimics軟件,對枕骨及寰椎進(jìn)行三維CT重建,模擬置入直徑3.5mm的枕骨髁螺釘,測量枕骨髁長、寬、高、進(jìn)釘點至枕骨內(nèi)側(cè)緣和顱底部的距離,并通過3-matic軟件測量枕骨髁螺釘進(jìn)釘長度、頭傾角、內(nèi)傾角及與枕骨切線間的切線角,比較枕骨髁解剖學(xué)參數(shù)與螺釘置釘參數(shù)間的差異。結(jié)果:共模擬置入100枚枕骨髁螺釘,三維模型大體觀察均無舌下神經(jīng)管、寰枕關(guān)節(jié)面和枕骨髁內(nèi)外側(cè)壁的損傷。男、女枕骨髁解剖學(xué)參數(shù)及螺釘進(jìn)釘點參數(shù)、置釘后枕骨髁螺釘置釘參數(shù)左右兩側(cè)比較均無統(tǒng)計學(xué)差異(P0.05)。男性枕骨髁解剖學(xué)長、寬、高、進(jìn)釘點距枕髁內(nèi)側(cè)緣水平距離及距顱底垂直距離分別為22.00±1.67mm、11.27±1.21mm、10.72±1.13mm、5.37±0.10mm及2.95±0.47mm,女性分別為21.07±1.43mm、10.64±0.81mm、9.62±0.95mm、5.05±0.10mm及3.04±0.48mm,女性枕骨髁長、寬、高及進(jìn)釘點距枕髁內(nèi)側(cè)緣水平距離均顯著性小于男性(P0.05),進(jìn)釘點距顱底垂直距離與男性無統(tǒng)計學(xué)差異(P0.05);置釘后男性頭傾角、顱底切線角、內(nèi)傾角及進(jìn)釘長度分別為3.90°±2.01°、12.45°±4.73°、28.15°±4.53°、22.47±1.48mm,女性分別4.19°±2.01°、11.25°±4.61°、30.00°±4.70°、21.59±1.62mm,女性進(jìn)釘長度較男性短(P0.05),頭傾角、顱底切線角及內(nèi)傾角男女性無統(tǒng)計學(xué)差異(P0.05)。頭傾角與切線角間存在正相關(guān)性(r=0.519,P0.05),與其余置釘參數(shù)間無相關(guān)性(P0.05)。結(jié)論 :國人女性枕骨髁解剖學(xué)參數(shù)與男性存在差異,枕骨髁三維重建下模擬螺釘置入顯示男女性枕骨髁均可安全容納螺釘置入固定,理論上切線角可結(jié)合進(jìn)釘點及內(nèi)傾角指導(dǎo)枕骨髁螺釘?shù)陌踩萌搿?br/>[Abstract]:Objective: to study the safety of posterior occipital condylar screw placement and the correlation between the parameters of occipital condyle screw placement. Methods: 50 patients with normal occipitocervical shape were selected, 25 males and 25 females, aged 2560 years, 38.5 鹵7.6 years old. Excluding fracture and dislocation, infection, tumor, malformation and degenerative change, the data were imported into Mimics software to reconstruct occipital bone and atlas, simulate occipital condylar screw with diameter 3.5mm, and measure the length, width and height of occipital condyle. The distance from the point of entry to the medial margin of occipital bone and the base of skull was measured by 3-matic software. The length of the screw, the angle of head inclination, the angle of internal inclination and the angle of tangent between the occipital condyle and occipital bone were measured by 3-matic software, and the differences between the anatomical parameters of occipital condyle and the parameters of screw insertion were compared. Results: a total of 100 occipital condylar screws were implanted. There were no hypoglossal nerve canal, atlanto-occipital articular surface and lateral wall of occipital condyle. The anatomic parameters of the condyle of the occipital bone and the point of screw entry were not significantly different between the male and the female, and there was no significant difference between the right and left sides of the parameters of the screw insertion of the occipital condyle. The anatomical length, width and height of the occipital condyle in males were 22.00 鹵1.67mm and 11.27 鹵1.21mm respectively, and 2.95 鹵0.47mm, 21.07 鹵1.43mm, 9.62 鹵0.95mm, 5.05 鹵0.10mm and 3.04 鹵0.48mm, respectively. The occipital bone length, width and width of the occipital bone in males were 3.04 鹵0.48mm and 21.07 鹵1.43mm respectively, and those in males were 22.00 鹵1.67mm, 10.72 鹵1.13mm and 2.95 鹵0.47mm, respectively, and those in females were 21.07 鹵1.43mm, 9.62 鹵0.95mm, 5.05 鹵0.10mm and 3.04 鹵0.48mm, respectively. The horizontal distance between the height and the point of entry to the medial margin of the occipital condyle was significantly lower than that of the male (P 0.05), and there was no significant difference in the vertical distance between the point and the base of the skull (P 0.05). The inclinations and the length of the nail were 3.90 擄鹵2.01 擄/ 12.45 擄鹵4.73 擄/ 28.15 擄鹵4.53 擄/ 22.47 鹵1.48mm, respectively, and 4.19 擄鹵2.01 擄/ 11.25 擄鹵4.61 擄/ 11.59 鹵1.62mm respectively. The length of the nail in female was shorter than that in the male (P 0.05N), and there was no significant difference in the angle of head inclination, the angle of tangent line of skull base and the angle of internal inclination. There was a positive correlation between the head inclination angle and the tangent angle, and there was no correlation between the head inclination angle and the tangent angle. Conclusion: the anatomic parameters of occipital condyle in Chinese women are different from those in men. Under the three-dimensional reconstruction of occipital condyle, the simulated screw placement shows that the occipital condyle of male and female can safely accommodate the screw placement and fixation. Theoretically, tangent angle can be combined with insertion point and inclination angle to guide the safe placement of occipital condylar screw.
【作者單位】： 寧波大學(xué)醫(yī)學(xué)院;浙江省寧波市第六醫(yī)院骨科;
【基金】：國家自然科學(xué)基金面上項目(81572217) 浙江省醫(yī)藥衛(wèi)生科技項目(201340612);浙江省醫(yī)藥衛(wèi)生科技項目(2015112091)
【分類號】：R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前4條

1 孫沖;劉小臻;尹德超;鄭修軍;;枕骨髁螺釘在枕頸融合中應(yīng)用的研究進(jìn)展[J];齊魯醫(yī)學(xué)雜志;2012年06期

2 溫超輪;李嚴(yán)兵;;枕骨髁螺釘內(nèi)固定行枕頸融合術(shù)的研究進(jìn)展[J];中國脊柱脊髓雜志;2014年01期

3 陳明,夏仁云;動力髖/髁螺釘治療股骨近關(guān)節(jié)骨折失敗原因及防治[J];臨床骨科雜志;2003年02期

4 黃軒;李鳳寧;張帆;王琨;陳智;陽青松;黨瑞山;沈洪興;李明;;三維打印個體化導(dǎo)航模板在枕骨髁螺釘固定技術(shù)中的應(yīng)用研究[J];中國脊柱脊髓雜志;2014年05期

相關(guān)碩士學(xué)位論文 前1條

1 余作沖;枕骨髁螺釘技術(shù)可行性的應(yīng)用解剖學(xué)分析[D];復(fù)旦大學(xué);2014年

，

本文編號：1961850