齿状突螺钉钢板内固定系统的研制及解剖学可行性分析

Odontoid screw plate fixation system, designation and its anatomical analysis

中文关键词:  前路钢板固定  齿状突骨折  解剖学  Hangman骨折  Mimics

英文关键词:Anterior plate fixation  Odontoid fracture  Anatomy  Hangman fracture  Mimics

中文摘要:

  【摘要】 目的：自行设计与制作齿状突螺钉钢板内固定系统，并验证其解剖学可行性。方法：收集40例健康志愿者（其中男20例，女20例，年龄22～32岁，平均26岁）的颈椎CT数据，导入到Mimics 15.01中，通过Mimics软件测量枢椎（C2）、第3颈椎（C3）及C2/3椎间盘的相关解剖参数，包括：齿状突高度、齿状突前后径、齿状突横径、枢椎椎体前缘高度、枢椎椎体后缘高度、枢椎椎体前后径、枢椎椎体横径、枢椎前下唇的高度、枢椎前下唇的宽度、枢椎前唇与枢椎椎体后缘最高点连线与C2椎体下终板面的夹角、齿状突轴径与冠状面的夹角、在枢椎椎体横径测量平面测量该切面枢椎椎体前突部分的夹角、枢椎椎体矢状面前缘与C2~C3椎体前缘矢状面切线的夹角、C3椎体前后径、C3椎体横径、C3椎体前缘高度、C3椎体后缘高度、C3前下唇的高度、C2/3前部椎间盘厚度、C2/3中部椎间盘厚度、C2/3后部椎间盘厚度、C3椎体正中矢状位前缘最高点与后缘最低点连线与C3椎体上终板面的夹角、C3上终板面与C2~C3椎体前缘矢状面切线的夹角、齿状突理想钉道与C2~C3椎体前缘矢状面切线的夹角。并进行统计学分析，为齿状突螺钉钢板内固定系统的设计提供相关解剖参数范围，在此基础上设计与制作齿状突螺钉钢板内固定系统，并将其在Mimics软件上和尸体标本上进行模拟手术。在Mimics软件上模拟齿状突螺钉钢板内固定系统置入后，通过Mimics软件上的透明功能观察螺钉通道在C2和C3中的位置是否合理，尸体模拟手术后通过对标本行CT扫描和三维重建，观察钉道是否准确。结果：根据上述C2、C3及C2/3椎间盘的相关解剖参数测量结果设计、采用医用钛合金材质（Ti-6A1-4V）制作的齿状突螺钉钢板内固定系统，主要由螺钉固定板、C2/3椎间融合器和相关配件组成，其中配件包括齿状突固定部件、椎体锚定部件和锁定部件。齿状突螺钉钢板内固定系统在Mimics软件上和尸体标本上模拟手术置入后，通过透明功能和CT检查显示钉道位置合理。结论：自行研制的齿状突螺钉钢板内固定系统的置入在解剖学上具有可行性。

英文摘要:

  【Abstract】 Objectives: To offer the anatomical data and feasibility of self-designed odontoid screw plate fixation system(OSPFS). Methods: 40 healthy volunteers′[20 of each gender, age 22-32 years(mean 26 years)] CT data of cervical spine were collected and imported into Mimics software, the data included: dens height, dens anteroposterior diameter, dens width, C2 vertebral anterior height, C2 vertebral posterior height, C2 vertebral body diameter, C2 vertebral body width, C2 anterior inferior lip height, C2 anterior inferior lip width, the angle between C2 inferior end plate and the line of C2 anterior lip and the highest point of C2 vertebral posterior marginal, the angle between coronal plane and the axis of odontoid, the angle of C2 vertebral body which was measured in the plane with C2 vertebral body width, the angle between C2 sagittal plane front edge and C2-C3 vertebral anterior edge sagittal plane tangent line, C3 vertebral body diameter, C3 vertebral body width, C3 vertebral anterior height, C3 vertebral posterior height, C3 anterior inferior lip height, C2/3 anterior intervertebral disk thickness, C2/3 middle intervertebral disk thickness, C2/3 posterior intervertebral disk thickness, the angle between C3 superior end plate and the line of C3 vertebral sagittal highest point of the leading edge and the lowest point of vertebral posterior marginal, the angle between C3 superior end plate and C2-C3 vertebral anterior edge sagittal plane tangent line, the angle between dens′ ideal screw channel and C2-C3 vertebral anterior edge sagittal plane tangent line. All these data were analyzed by SPSS software to work out relevant parameter range to OSPFS, the design and manufacture of odontoid screw plate fixation system are on the basis of these data, and simulated surgery in Mimics software and on cadavers． After simulated surgery, the accuracy of screw channel position were detected by the transparent function of Mimics and undergoing CT scanning and three-dimensional reconstruction. Results: The OSPFS was designed based on the C2, C3 and C2/3 related anatomical measurements completely. OSPFS consisted of screw fixing plate, C2/3 disc fusion device and related accessories, which used medical titanium alloy material(Ti-6Al-4V) manufacturing. The complex included dens fixation parts, vertebral body anchoring parts and locking parts. The simulated surgery in Mimics software and on cadavers was successfully carried out which demonstrated the placement of OSPFS was feasible. The screw channel position of odontoid screw plate were accurate which detected by the transparent function of Mimics and undergoing CT scanning and three-dimensional reconstruction. Conclusions: The placement of self-designed OSPFS in C2-3 complex is feasible anatomically.