| Part one:The applied anatomy transoral approach with mandibulomtomy and madibulogssotomyObjective To provide anatomical profile of the cranio-cervical region for the surgical treatment of ventral atlantoaxial lesions through transoropharyngeal approach. Methods Simulate transoral expanded approach with mandibulotomy and mandibuloglossotomy Surgery on eight Adult head and neck anatomy specimens, microsurgical anatomy was performed layer by layer for observing The level of the pharynx posterior wall,The starting point and distribution of bilateral musculus longus colli,the course of bilateral vertebral artery, Positional relation of uncovertebral joint and musculus longus colli,middle superior cervical vertebra,.sagittal and coronary expose range of transoral expanded approach with mandibulotomy and mandibuloglossotomy and measure Relevant anatomic parameters。 Results 1.Dissection observation of the pharynx posterior wall soft tissue; The anatomy of the hierarchy as follows from Pharynx posterior wall to Vertebral body bone surface:the mucous membrane layer, submucosa, pharyngeal constrictor, buccal pharynx fascia, vertebral front fascia and anterior longitudinal ligament, blood vessels between pharynx posterior wall and vertebral anterial, blood vessels distribution is dense on both sides and sparse in the middle.2. Related anatomic parameters of vertebral artery,measurement results of external diameter of the left and right vertebral artery, distance from Vertebral artery to the ipsilateral musculus longus colli, distance from Vertebral artery to the ipsilateral Luschka was compared with paired t test, no statistical significance (p>0.05),mm;external diameter of Bilateral vertebral artery on C2 plane was 2.92±0.44mm, on C3 plane was 3.01±0.49mm. on C4 plane was. 3.15±0.41mm, on C5 plane was 3.24±0.51mm。 Left and right vertebral artery spacing on C2 plane was 32.67±6.98mm, on C3 plane was 32.34±3.56mm, on C4 plane was31.34±2.56mm, on C5 plane was 33.12±4.58mm;the distance from Vertebral artery to the ipsilateral musculus longus colli C2 on plane was 9.85±0.43mm, on C3 plane was8.67±0.61mm, on C4 plane was7.73±1.19mm, on C5 plane was8.36±1.54mm;the distance from Vertebral artery to the ipsilateral Luschka on C2 plane was1.38±0.32mm, on C3 plane was1.47±0.50mm, on C4 plane was1.44±0.46mm, on C5 plane was1.40±0.59mm.3.Measurement results of related anatomic parameters of musculus longus colli measurement results of The width of Left and right sides of musculus longus colli was compared with pared t test,no statistical significance(p>0.05),combine statistical magnitude,The width of Left and right sides of musculus longus colli on C2 plane was 19.98±5.24mm, on C3 plane was20.71±4.82mm, on C4 plane was21.45±3.97mm, on C5 plane was21.39±5.04mm;space between two musculus longus colli on C2 plane was8.73±2.56mm, on C3 plane was10.24±2.13mm, on C4 plane was11.41±2.60mm, on C5 plane was12.02±2.48mm. 4.Sagittal exposure range of Two kinds of transoropharyngeal approach,the sagittal exposure angle of transoral approach with mandibulotomy was (62.49±3.70) °,the sagittal exposure angle of transoral approach with mandibuloglossotomy was (72.06±2.74) °,the exposure range of transoral approach with mandibuloglossotomy increased by 9.57° compared with transoral approach with mandibulotomy,sagittal exposure angle of Two kinds of transoropharyngeal approach were compared with the pared t test,and differences of the exposure range of two kinds of transoropharyngeal approach is Statistically significant.the maximum exposure range of transoral approach with mandibuloglossotomy is from slop to c6 superior end plate.Conclusion 1.transoral approach with mandibulotomy and mandibuloglossotomy is safe and feasible which suitable for lesions of slope and upper cervical spine simutaneously involving long segmental vertebral of lower cervical spine ventral and diffuse spinal cord ventral pathological changes(such as spinal primary tumors, spinal metastases, spinal tuberculosis, spinal deformity, spinal fractures),and for congenital mouth narrow crack or restrictionofmouthopening due to various reasons (such as primary spinal tumors, spinal metastases, spinal tuberculosis, spinal deformity, spinal fractures).2.transoral expanded approach with mandibulotomy and mandibuloglossotomy in upper anterior cervical surgery expose boundary To both sides the vertebral artery as its security boundary, medial border of musculus longus colli,uncovertebral joint is the first and second security of anatomical orientation marksPart two:The treatment for upper-middle cervical tumor using atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approachObjective To explore the clinical efficacy of upper-middle cervical tumor using atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approach. Methods 5 patients with upper-middle cervical tumor From march 2009 to june 2013 was reviewed, among them,5 cases with primary Cervical tumors. All patients undergone tumor resection and atypical titanium mesh filled with Autogenous iliac bone graft fusion internal fixation, unite posterior approach Tumor resection and occipito-cervical fusion internal fixation. Preoperative JOA scoring average (9.80±2.68). Results All patient wounds reached Class-A healing 2 weeks postoperative, without spinal cord,vessels and nerve injury during operation, without postoperative complications such as infections, after mean 18.4±6.15 months(arrange 12 to 27) follow-up, recent curative effect was satisfied postoperative, focal pain and Neurologic symptoms was improved, Postoperative JOA scoring was 11～16, mean(13.4±1.82). matching t test was performed to compare Preoperative and postoperative scores, The difference was statistically significant(P<0.001).1 case with plasmacytoma recurred 27 months postoperative, turn to the other hospital for treatments. All patients with postoperative follow-up review cervical positive lateral X ray in internal fixation stability, location, bony fusion 3-6 month after surgery. Conclusion The recent curative effects of atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approach unite postrrior approach tumor resection and occipito-cervical fusion for upper-middle cervical tumor was satisfied, long term efficacy needs to be observed further. tumor using atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approachObjective To explore the clinical efficacy of upper-middle cervical tumor using atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approach. Methods 5 patients with upper-middle cervical tumor From march 2009 to june 2013 was reviewed, among them,5 cases with primary Cervical tumors. All patients undergone tumor resection and atypical titanium mesh filled with Autogenous iliac bone graft fusion internal fixation, unite posterior approach Tumor resection and occipito-cervical fusion internal fixation. Preoperative JOA scoring average (9.80±2.68). Results All patient wounds reached Class-A healing 2 weeks postoperative, without spinal cord,vessels and nerve injury during operation, without postoperative complications such as infections, after mean 18.4±6.15 months(arrange 12 to 27) follow-up, recent curative effect was satisfied postoperative, focal pain and Neurologic symptoms was improved, Postoperative JOA scoring was 11～16, mean(13.4±1.82). matching t test was performed to compare Preoperative and postoperative scores, The difference was statistically significant(P<0.001).1 case with plasmacytoma recurred 27 months postoperative, turn to the other hospital for treatments. All patients with postoperative follow-up review cervical positive lateral X ray in internal fixation stability, location, bony fusion 3-6 month after surgery. Conclusion The recent curative effects of atypical titanium mesh internal fixation and reconstruction under transoral-transabiomandibular approach unite postrrior approach tumor resection and occipito-cervical fusion for upper-middle cervical tumor was satisfied, long term efficacy needs to be observed further.Part three:preliminary design of partial anterior approach cervical fusion fixator.Objective To make preliminary design of anterior cervical fusion fixator Methods To design and improve on the basis of anterior cervical plate system, according to the upper cervical lesion clearance, vertebral body Reconstruction and the internal fixation need, using CAD software to draw figures. Results and conclusion the preliminary design on the holder in anterior cervical fusion... |
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