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
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
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。
