寰枢椎损伤解剖学基础及植入物内固定治疗的生物力学特征

Anatomic basic of atlantoaxial trauma and biomechanical features of grafting fixation treatment

背景:寰枢椎疾病的发病率逐年上升,由于其解剖结构及毗邻关系复杂,因此选择正确的内固定技术对疾病的治疗起着至关重要的作用。目的:综述寰枢椎损伤的解剖学基础及内固定治疗技术的进展,指导临床应用。方法:由第一作者检索万方数据库(http://www.wanfangdata.com.cn)及Pubmed数据库(http://www.ncbi.nlm.nih.gov/pubmed)中1974/2010已发表的关于寰枢椎解剖及其内固定技术的文献,在标题和摘要中以"寰枢椎;解剖学;内固定"或"atlantoaxial;anatomy;interal fixation"为检索词进行检索。选择文章内容与寰枢椎解剖学及内固定技术相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到114篇文献,根据纳入标准选择26篇文章进行综述。结果与结论:寰枢椎作为枕颈移行部,是构成头颅旋转及屈伸运动的重要结构,因其邻近颈髓、椎动脉和颈神经等重要结构,任何原因所导致的寰枢椎和韧带的损伤,均可导致寰枢椎不稳,目前寰枢椎内固定技术繁多,应根据患处解剖特点、各种方法的适应证,以及医生的操作能力,来选择一个最合适的技术方法。

BACKGROUND： Atlantoaxial disease incidence increased year by year, because of its anatomical structure and the adjacent complex relationship, it plays a vital role in choosing the correct fixation for the treatment of disease. OBJECTIVE： To summarize the atlantoaxial anatomy of injury and the progress of internal fixation techniques for clinical applications. METHODS： Literatures about atlantoaxial anatomy and fixation from Wanfang and PubMed database published from 1974 to 2010 were searched by the first author. The key terms were ＂atlantoaxial, anatomy, internal fixation＂ both in English and Chinese. Papers published recently or in authoritative journals were selected. Totally 116 documents were initial searched and 28 included in this review. RESULTS AND CONCLUSION： Atlantoaxial occipitocervical migration is an important structure for construction of head rotation and flexion and extension. Because it closes to spinal cord, vertebral artery, cervical nerve and other important structures, any reason caused atlantoaxial or ligament damage can lead to atlantoaxial instability. Variously methods can treat atlantoaxial fixation however, an appropriate technology should be selected based on anatomical characteristics of the lesion, the indications of various methods, and the operational capacity of the surgeon.