| Objective: By analyzing and measuring adult pillow neck midlinesagittal CT, to investigate preoperative designs of the occipital outerplate flip, to provide imaging parameters for occipitocervical fusioncombining the reversed transplantation of periosteal occipital outerplate flap with internal fixation, and to apply it to clinic work for thefirst time.Method:The first part is the imaging study: to randomly select160pillowneck sagittal CTs of the normal adult males and females, by observing thelower part of the image of the pillow scales we artificially divided theminto the arc-type occipital image group (52men,38women, the ageof male group was51.89±14.64years old, the age of female group was49.40±16.05years old) and the peaceful-straight-type occipital imagegroup (46men,24women, the age of male group was53.57±17.07yearsold, the age of female group was50.29±12.02years old):1, the arc-type occipital image group: A method (through1cm abovethe midpoint of the trailing edge of the foramen magnum, the tangent ofthe arc-shaped diploe image) and B method (through pillow inside andoutside carina midpoint, the tangent of the arc-shaped diploe image)to design the flipping of occipital outer plate, to determine thefeasibility of A and B methods and to obtain preoperative imagingparameters of the flipping of the arc-type occipital outer plate throughthe measurement of relevant indicators of A and B methods. 2, the peaceful-straight-type occipital image group: to design theflipping of occipital outer plate through the establishment of anequilateral triangle mathematical model, to determine its feasibilityand to obtain preoperative imaging parameters of the flipping of thepeaceful-straight-type occipital outer plate through the measurement ofrelevant indicators of the establishment of an equilateral trianglemathematical model.The second part is preliminary clinical application: to select12patients for the operation with preoperative、postoperative and follow-upclinical data, to evaluate its clinical efficacy and bone graft fusion.Results:1, the arc-type occipital image group: in adults(including adultmale group and adult female group)there was statistical significance(p＜0.05)between the flip ratio(desired flap length/accessibility maximumflap length)according to method A or B method and the biggest flip ratio(100%).Based on A method to flip the occipital outer plate, adult malegroup and adult female group showed no statistical significance(p＞0.05);based on B method to flip the occipital outer plate, adult male group andadult female group showed no statistical significance(p＞0.05). To flipthe occipital outer plate in the same person (including adult male groupand adult female group)there was statistical significance(p＜0.05)between A method and B method.2, the peaceful-straight-type occipital image group: to flipoccipital outer plate through the establishment of an equilateraltriangle mathematical model, adult male group and adult female groupshowed no statistical significance (p＞0.05); To flip the occipital outerplate in the same person (including adult male group and adult femalegroup) there was statistical significance(p＜0.05)between the methodbased on an equilateral triangle and the other method using1cm above the midpoint of the trailing edge of the foramen magnum as the turning pointof the occipital outer plate.3，12patients were all successful, with postoperative nervecompression symptoms and imaging cervical stenosis improvedsignificantly. After six months: eleven cases were bone fusions, one diedof lung cancer failed to obtain the imaging data.Conclusion:1, The adult’s image of pillow scale in the pillow neck sagittalCT can be broadly divided into the arc-type occipital image and thepeaceful-straight-type occipital image. There are different methods todesign the flipping of occipital outer plate for both the arc-typeoccipital image and the peaceful-straight-type occipital image.2, Preoperative measurements of the pillow neck sagittal CT canprovide imaging parameters for the intraoperative flipping of occipitalouter plate: the turn point position, the flap length and width, thechiselling point position.3, Preliminary clinical application proved that it can get a goodclinical efficacy and bone fusion for occipitocervical fusion combiningthe reversed transplantation of periosteal occipital outer plate flapwith internal fixation. |
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