经口咽前路寰枢椎复位钢板治疗难复性寰枢椎脱位

Design and preliminary clinical application of transoralpharyngeal atlantoaxial reduction plate

目的设计经口咽前路寰枢椎复位钢板系统 (transoralpharyngealatlantoaxialreductionplate ,TARP) ,评价其生物力学性能 ,观察临床应用效果。方法 研制设计一种新型的经口咽前路寰枢椎复位钢板系统 ,该系统包括一蝶形钛合金钢板、自锁螺钉和寰枢椎复位器等配套安装器械。将此系统在 12具C0 ～C3 新鲜标本上分别进行了三维运动测试 (n =6 )和拔出力实验 (n =12 ) ,比较其生物力学性能 ,并临床治疗难复性寰枢椎脱位患者 5例。结果 TARP系统设计有巧妙的即时复位机制。TARP的生物力学性能与现行的寰枢椎融合Magerl+Brooks固定等效 ,较其它三种方法 (前路经枢椎体寰椎侧块螺钉、后路Magerl经关节螺钉和后路Brooks钢丝 )具有更坚强的固定作用 ,TARP的寰椎和枢椎固定螺钉固定牢靠 ,具有良好的抗拔出性能。经难复性寰枢椎脱位的临床应用 ,TARP能达即时复位作用 ,手术操作可行 ,效果显著。结论 TARP设计新颖独到 ,具有良好的生物力学性能 ,手术能达即时复位 ,固定效果好 ,为临床提供了一个崭新的治疗方法。

Objective To design transoralpharyngeal atlantoaxial reduction plate(TARP), to evaluate its biomechanical performance and to observe its preliminary clinical effects. Methods A brand-new TARP system was designed, including a butterfly-shaped titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. 12 fresh C_0～C_3 specimen were designed for biomechanical test including range of motion (ROM)(n=6) and screw pull-out strength(n=12). Preliminary clinical applications of TARP were reported. Results The reduction mechanism of the TARP system was well designed. TARP had equal effects with Magerl+Brooks and it was more stable than the other three atlantoaxial fixators that were widely used in the clinics: Magerl, Brooks and anterior transarticular screw fixation through C_2 vertebral body. TARP's C_1 and C_2 screws were strong enough for atlantoaxial arthrodesis and their anti-pull-out performance was excellent. Clinical applications on irreducible atlantoaxial dislocation showed that TARP had the function of instant reduction and the operation was feasible with significant effects. Conclusion TARP's design was innovative and had excellent biomechanical performance. The operation procedures were simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation was strong. Overall, TARP is creatively designed and can be beneficial to the future treatment.