【作者】 杨朝垒；

【导师】 王利民；

【作者基本信息】 郑州大学 ， 外科学， 2011， 硕士

【摘要】 背景与目的颅颈交界区作为枕骨与上颈椎的过渡区域,主要由围绕枕骨大孔的枕骨、寰椎、枢椎及其周围韧带组成,是容纳延髓至颈髓过渡区的管道,其形态结构复杂,功能特殊,病变往往引起明显的临床症状,甚至危及生命。临床上主要采取手术减压同时联合内固定系统治疗颅颈交界区畸形,如枕颈融合术、寰枢融合术等。手术的目的是增强该区域的稳定性,而内固定系统提供的稳定只是暂时的,只能通过骨性融合才能实现最终的稳定,这也就要求手术区域有充分的植骨区及植骨材料有较高的融合率。目前临床上应用的植骨材料主要有自体骨、同种异体骨、异种骨、生物活性材料和骨生长因子等,而各种材料都有其局限性。本研究在颅颈交界区影像学解剖参数测量的基础上,采用复合生物材料设计出符合枕颈解剖结构的人工骨板,为临床枕颈后路手术提供一种新型的植骨材料。材料与方法1影像学参数测量收集63例颅颈交界区畸形患者的影像学资料,测量枢椎椎弓根进钉点间距及术后连接棒的弧所对应的圆心角及弧两点间距离、枢椎椎弓根上倾角、枢椎椎弓根内倾角；收集59例正常上颈椎的影像学资料,分别测量枢椎椎弓根进钉点间距、寰椎平面脊髓后缘至椎管的距离,共七个相关参数指标。2颅颈交界区人工骨板的研制在影像学测量的基础之上,根据各个参数指标设计出符合枕颈解剖结构的植骨骨板。结果1影像学结果经过测量,患者组枢椎椎弓根进钉点间距、枢椎椎弓根上倾角、枢椎椎弓根内倾角、术后钉棒的弧长所对应的圆心角、弧两点间距离五个参数样本均数及正常组枢椎椎弓根进钉点间距离、寰椎平面脊髓后缘至椎管的距离两个参数样本均数分别为：35.36±3.12(29.0-41.6)mm、、41.74±7.21(23.2～57.2)°、33.22±3.05(20.6～43.4)°、109.94±8.33(98.7～128.1)°、47.14±7.35(35.3～66.3)mm、34.03±3.49(28.0-38.5)mm、4.74±0.94(3.1-6.6)mm。2人工骨板的结构特点设计的人工骨板具有巧妙的几何外形和结构设计、良好的生物学性能、安装和观察方便等特点。结论1.在影像学测量的基础上设计的人工骨板可以很好地覆盖在手术减压后的植骨床上,避免压迫颈髓,术后随访观察方便,可以作为枕颈后路手术的植骨材料。2.可以根据测量所得数据将人工骨板设计为多个型号,满足患者个体化差异的需求。更多还原

【Abstract】 Background and ObjectiveThe craniocervical junction which is consist of occipital, atlas, axis, and its sur-rounding ligament, is considered as transition zone between occipital bone and the upper cervical, and contained the medulla oblongata. Because of the importance of position, The Lesions such as vessels and nerves often cause significant clinical symptoms, Even life threatening.Clinically, Surgical decompression and internal fixation system such as occipitocervical fusion or atlanto-axial fusion is used for craniocervical junction deformity, however the technique requires sufficient bone graft area to improve the fusion rate and enhance the stability in this area. Currently the graft materials basically contained autogeneous bone, allograft bone,heterogeneous bone, Bioactive materials and bone growth factors, however all kinds of materials has its advantages and disadvantages.On the basis of imaging anatomical parameters of the craniocervical junction, we designed the artifical bone lamella accord with craniocervical junction anatomy asbone graft material of posterior surgery. Materials and methods1 Imaging anatomy measurementAfter collecting the imaging data of 63 patients with clinical craniocervical malformation, we measured the related parameters of anatomical atlas and axis. The five relevant parameters are following: the length of the axis pedicle screw point, the central angle corresponds to the arc of connecting rods, the distance between two points of the arc,the upper oblique angle of axis vertebral pedicle, the inside oblique angle of axis vertebral pedicle; furthermore, we also collected and measured the imaging data of 50 normal people, the two parameters are the length of the axis pedicle screw point and the distance from spinal cord to the anterior margin of spinal canal in atlas plane.2 The design of artifical bone lamella in craniovertebral junctionWe design the bone graft lamella accord with craniocervical junction anatomy on the basis of imaging anatomical parameters.we call it the artifical bone lamella.Results1 Imaging anatomy parametersFor group of patients, the length of the axis pedicle screw point, the central angle corresponds to the arc of connecting rods, the distance between two points of the arc,the upper oblique angle of axis vertebral pedicle, the inside oblique angle of axis vertebral pedicle were 35.36±3.12 (29.0-41.6) mm、、41.74±7.21 (23.2-57.2)。、33.22±6.05 (20.6～43.4)。、109.94±8.33 (98.7-128.1)。、47.1±7.35 (35.3-66.3) mm, respectively. For normal group, the length of the axis pedicle screw point and the distance from spinal cord to the anterior margin of spinal canal in atlas plane were 34.03±3.49 (28.0-38.5) mm、4.74±0.94 (3.1-6.6) mm, respectively.2 The structural features of the artifical bone lamellaThe artifical bone lamella has smart geometrical shape and structure design, favourable biological performance, and it is convenient to install and observe after operation.Conclusion1 The artifical bone lamella which can beautifully cover the bone graft bed of surgical decompression, avoid oppressing cervical spinal cord, and the follow-up is convenient, is a excellent bone graft material in posterior surgery of the craniocervical junction.2 The artifical bone lamella can be designed for multiple models that can satisfy the demand of individual differences.更多还原