In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dis...In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults＇ fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the .width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces： mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.展开更多
The derangement of the atlantoaxiai joint is one of main cervical sources of dizziness andheadache,which were based on the observation on the anatomy of the upper cervicalvertebrae,analysis of X-ray film of the atlant...The derangement of the atlantoaxiai joint is one of main cervical sources of dizziness andheadache,which were based on the observation on the anatomy of the upper cervicalvertebrae,analysis of X-ray film of the atlantoaxial joint,and the manipulative treatmentin 35 patients with cervical spondylosis.The clinical diagnosis of derangement consists of:dizziness,headache,prominence and tenderness on one side of the affected vertebra,deviation of the dens for 1mm-4mm on the open-mouth X-ray film,abnormal movementof the atlantoaxial joint on head-rotated open-mouth X-ray film.An accurate and delicateadiustment is the most effective treatment.展开更多
背景:0-6岁儿童各类严重创伤、畸形、肿瘤、结核、炎症等均极易导致枕寰枢复合体区损伤。当出现损伤压迫延髓、上颈髓、诸多神经血管等危重情况时需手术矫治以恢复该区力学稳定,但鉴于该期儿童有不同于青少年和成人的发育特征,国内外学...背景:0-6岁儿童各类严重创伤、畸形、肿瘤、结核、炎症等均极易导致枕寰枢复合体区损伤。当出现损伤压迫延髓、上颈髓、诸多神经血管等危重情况时需手术矫治以恢复该区力学稳定,但鉴于该期儿童有不同于青少年和成人的发育特征,国内外学者对其前、后或侧路手术内固定器械方案设计、矫形固定和力学机制等至今仍无深入研究和统一认识。目的:通过分析0-6岁儿童枕寰枢复合体区形态特征基础数据综述其形态发育规律和力学机制,将填充国人儿童该区发育形态学、影像学和微结构力学数据库,并为发育性、外伤性该区疾病的预防、诊治及内固定术器械设计、研发等提供理论依据。方法:用计算机检索2004年1月至2017年12月PubMed数据库、中国知网及万方数据库的相关文章,英文检索词"0-6 years old,pediatric,occipital atlantoaxial complex,anatomy,biomechanical";中文检索词"0-6岁小儿,枕寰枢复合体,解剖,生物力学",共检索到82篇相关文献,58篇文献符合纳入标准。结果与结论:(1)0-6岁儿童寰枢椎及颅底复杂解剖结构更加细小且变异大、毗邻关系复杂,无法以成人或青少年螺钉内技术相关数据简单地应用于"非成人等比例缩小"的发育中幼儿,加之手术风险极高,故提高置钉的准确性和降低失误率已成为曾经"生命禁区"内固定能否普遍基层开展的关键所在;(2)0-6岁小儿枕寰枢复合体区严重损伤应内固定治疗,后路内固定是常用术式,因常合并多种畸形,各患儿的骨质结构差异大,内固定置钉更为困难。展开更多
目的初步探讨后路寰枢椎螺钉钢板固定、自体植骨融合治疗儿童寰枢椎不稳定及脱位的疗效。方法本研究为回顾性研究,以2019年3月至2022年6月在首都医科大学附属北京儿童医院骨科接受后路寰枢椎钉板固定治疗的22例寰枢椎不稳定及脱位患儿...目的初步探讨后路寰枢椎螺钉钢板固定、自体植骨融合治疗儿童寰枢椎不稳定及脱位的疗效。方法本研究为回顾性研究,以2019年3月至2022年6月在首都医科大学附属北京儿童医院骨科接受后路寰枢椎钉板固定治疗的22例寰枢椎不稳定及脱位患儿为研究对象。男12例,女10例;年龄(8.2±2.8)岁。采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经系统分级评估手术前后脊髓损伤程度及改善情况。测量寰齿前间隙(atlanto-dens interval,ADI)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位情况;记录脊髓有效空间(space available for spinal cord,SAC),评估脊髓压迫情况;记录植骨融合以及并发症发生情况。结果22例均获随访,随访时间(45.8±14.5)个月。20例行一期后路寰枢椎钉板固定术,2例经口松解后再行后路复位融合术;22例患儿术中无一例脊髓或椎动脉损伤。术后及末次随访时的ADI分别为(2.6±1.3)mm、(2.7±1.0)mm,CAA分别为(143.1±6.4)°、(142.7±8.5)°,SAC分别为(18.7±3.4)mm、(18.9±3.0)mm;与术前ADI[(9.0±3.2)mm]、CAA[(120.5±13.1)°]、SAC[(13.6±5.2)mm]相比较,差异均有统计学意义(P<0.017)。末次随访时,术前有神经症状的13例患儿ASIA分级均达到E级,所有患儿颈椎CT重建可见骨性融合良好,寰枢椎均达到解剖复位,无一例内固定松动及断裂。结论采用后路寰枢椎钉板固定、自体髂骨松质骨植骨融合治疗儿童寰枢椎不稳定及脱位,可使寰枢椎获得解剖复位及良好固定,并可获得较理想的植骨融合效果。展开更多
Objective:To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting t...Objective:To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting the destroyed atlanto-odontoid joint in the orthopedic clinic. Methods:The relative anatomic parameters of 32 sets of fresh Chinese adults'atlanto-odontoid joint specimens were measured with a digital caliper and a goniometer, including the width of anterior arch of atlas(AW),the thickness of atlas at the junction of anterior arch and lateral mass(AD),the thickness and height of anterior tubercle of atlas(AT and AH),the middle height,length and width of the lateral mass(MHL,L and LW),the height, transverse and anteroposterior distance of odontoid process (DH,DW and DD),the retroversion angle of odontoid process(β°),the facial angle of odontoid process(θ°)and so on.The data were statistically analyzed in order to ascertain the morphological parameter ranges of artificial atlanto-odontoid joint.An artificial atlanto-odontoid joint was designed according to these data.The operations of anlanto-odontoid joint arthroplasty were conducted in 3 cases of adult cadaver specimens. Results:The width of AW was(20.45±1.53) mm,AD(3.91±1.32)mm,AT and AH(9.43±1.93) mm and(10.23±1.32)mm,respectively,MHL and LW (13.68±1.38)mm and(12.98±1.52)mm,respectively, DH(15.25±2.11)mm,DW and DD(9.69±1.38)mm and(11.26±1.02)mm,respectively,β°(12.23±4.27) degree,θ°(65.48±2.17)degree.The prosthesis was composed of atlas part,axis part and accessories.Neither the vertebral artery nor the medulla oblongata was injured. Conclusions:The design of artificial atlanto- odontoid joint is feasible according to these parameters. The artificial joint can not only rebuild the stability of atlanto-axial joint,but also reserve the rotation function between atlas and axis.Every part of the joint has their own parameter ranges in purpose to firm fixation, convenient operation and good motion without further injury.The prosthesis can be used for patients suffering from compression of medulla oblongata and resection of dens when it is required.展开更多
文摘In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults＇ fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the .width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces： mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.
文摘The derangement of the atlantoaxiai joint is one of main cervical sources of dizziness andheadache,which were based on the observation on the anatomy of the upper cervicalvertebrae,analysis of X-ray film of the atlantoaxial joint,and the manipulative treatmentin 35 patients with cervical spondylosis.The clinical diagnosis of derangement consists of:dizziness,headache,prominence and tenderness on one side of the affected vertebra,deviation of the dens for 1mm-4mm on the open-mouth X-ray film,abnormal movementof the atlantoaxial joint on head-rotated open-mouth X-ray film.An accurate and delicateadiustment is the most effective treatment.
文摘背景:0-6岁儿童各类严重创伤、畸形、肿瘤、结核、炎症等均极易导致枕寰枢复合体区损伤。当出现损伤压迫延髓、上颈髓、诸多神经血管等危重情况时需手术矫治以恢复该区力学稳定,但鉴于该期儿童有不同于青少年和成人的发育特征,国内外学者对其前、后或侧路手术内固定器械方案设计、矫形固定和力学机制等至今仍无深入研究和统一认识。目的:通过分析0-6岁儿童枕寰枢复合体区形态特征基础数据综述其形态发育规律和力学机制,将填充国人儿童该区发育形态学、影像学和微结构力学数据库,并为发育性、外伤性该区疾病的预防、诊治及内固定术器械设计、研发等提供理论依据。方法:用计算机检索2004年1月至2017年12月PubMed数据库、中国知网及万方数据库的相关文章,英文检索词"0-6 years old,pediatric,occipital atlantoaxial complex,anatomy,biomechanical";中文检索词"0-6岁小儿,枕寰枢复合体,解剖,生物力学",共检索到82篇相关文献,58篇文献符合纳入标准。结果与结论:(1)0-6岁儿童寰枢椎及颅底复杂解剖结构更加细小且变异大、毗邻关系复杂,无法以成人或青少年螺钉内技术相关数据简单地应用于"非成人等比例缩小"的发育中幼儿,加之手术风险极高,故提高置钉的准确性和降低失误率已成为曾经"生命禁区"内固定能否普遍基层开展的关键所在;(2)0-6岁小儿枕寰枢复合体区严重损伤应内固定治疗,后路内固定是常用术式,因常合并多种畸形,各患儿的骨质结构差异大,内固定置钉更为困难。
文摘目的初步探讨后路寰枢椎螺钉钢板固定、自体植骨融合治疗儿童寰枢椎不稳定及脱位的疗效。方法本研究为回顾性研究,以2019年3月至2022年6月在首都医科大学附属北京儿童医院骨科接受后路寰枢椎钉板固定治疗的22例寰枢椎不稳定及脱位患儿为研究对象。男12例,女10例;年龄(8.2±2.8)岁。采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经系统分级评估手术前后脊髓损伤程度及改善情况。测量寰齿前间隙(atlanto-dens interval,ADI)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位情况;记录脊髓有效空间(space available for spinal cord,SAC),评估脊髓压迫情况;记录植骨融合以及并发症发生情况。结果22例均获随访,随访时间(45.8±14.5)个月。20例行一期后路寰枢椎钉板固定术,2例经口松解后再行后路复位融合术;22例患儿术中无一例脊髓或椎动脉损伤。术后及末次随访时的ADI分别为(2.6±1.3)mm、(2.7±1.0)mm,CAA分别为(143.1±6.4)°、(142.7±8.5)°,SAC分别为(18.7±3.4)mm、(18.9±3.0)mm;与术前ADI[(9.0±3.2)mm]、CAA[(120.5±13.1)°]、SAC[(13.6±5.2)mm]相比较,差异均有统计学意义(P<0.017)。末次随访时,术前有神经症状的13例患儿ASIA分级均达到E级,所有患儿颈椎CT重建可见骨性融合良好,寰枢椎均达到解剖复位,无一例内固定松动及断裂。结论采用后路寰枢椎钉板固定、自体髂骨松质骨植骨融合治疗儿童寰枢椎不稳定及脱位,可使寰枢椎获得解剖复位及良好固定,并可获得较理想的植骨融合效果。
文摘Objective:To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting the destroyed atlanto-odontoid joint in the orthopedic clinic. Methods:The relative anatomic parameters of 32 sets of fresh Chinese adults'atlanto-odontoid joint specimens were measured with a digital caliper and a goniometer, including the width of anterior arch of atlas(AW),the thickness of atlas at the junction of anterior arch and lateral mass(AD),the thickness and height of anterior tubercle of atlas(AT and AH),the middle height,length and width of the lateral mass(MHL,L and LW),the height, transverse and anteroposterior distance of odontoid process (DH,DW and DD),the retroversion angle of odontoid process(β°),the facial angle of odontoid process(θ°)and so on.The data were statistically analyzed in order to ascertain the morphological parameter ranges of artificial atlanto-odontoid joint.An artificial atlanto-odontoid joint was designed according to these data.The operations of anlanto-odontoid joint arthroplasty were conducted in 3 cases of adult cadaver specimens. Results:The width of AW was(20.45±1.53) mm,AD(3.91±1.32)mm,AT and AH(9.43±1.93) mm and(10.23±1.32)mm,respectively,MHL and LW (13.68±1.38)mm and(12.98±1.52)mm,respectively, DH(15.25±2.11)mm,DW and DD(9.69±1.38)mm and(11.26±1.02)mm,respectively,β°(12.23±4.27) degree,θ°(65.48±2.17)degree.The prosthesis was composed of atlas part,axis part and accessories.Neither the vertebral artery nor the medulla oblongata was injured. Conclusions:The design of artificial atlanto- odontoid joint is feasible according to these parameters. The artificial joint can not only rebuild the stability of atlanto-axial joint,but also reserve the rotation function between atlas and axis.Every part of the joint has their own parameter ranges in purpose to firm fixation, convenient operation and good motion without further injury.The prosthesis can be used for patients suffering from compression of medulla oblongata and resection of dens when it is required.
