0-6岁儿童枕寰枢复合体发育特征及其生物力学的数字化研究

Occipitoatlantoaxial complex is an important junction andmechanics bridge forbrain and upper cervical spine. It has special morphological structure and complex function which could flexibly satisfy the multidimensional movements of head and neck. Besides, it alsoserves as a necessary mechanical support to protect the vital center-brainstemas well as the important structures like blood vessels and nerves around it.Children aged 0 to 6 kinds of severe traumas, malformation, tumors, tuberculosis and inflammationcould all cause the injury of occipitoatlantoaxial complex.When the injury compresses medulla oblongata, cervical cord, nerves and blood vessels, surgical correction is needed to recover the mechanics stability of the occipitoatlantoaxial complex region. However, the period of children are different from teenagers and adults in development characteristics, thus there is no further study and consistent understanding until nowon the instrument plan and design ofinternal fixation inanterior-posterior surgery and the orthopedic fixation among the scholars both at home and abroad.This study is to be carry out, in which 350 samples are chosen on basis of previous studies to multidimensionallydissect morphologicaldevelopment characteristics and change rules with age growth of occipitoatlantoaxial complex region of children among 0-6 years old from macroscopical to microcosmic angles. Then,through comparison and comprehensive analysis of the basic data, this study is to reveal the morphogenetic characteristics and mechanical mechanismof occipitoatlantoaxial complex. This study will enrich and expand the database of morphology, imaging and structural mechanicsof the development of children’s occipitoatlantoaxial complex , moreover，it will also provide theoretical basis for the prevention, diagnosis and treatment of developmental and traumatic diseases in occipitoatlantoaxial complex and also the design and development of instruments used in anterior -posterior internal fixation surgery.

枕寰枢复合体作为连接颅脑与上颈椎的重要枢纽和力学桥梁，其形态结构特殊、功能复杂，可灵活地满足头颈部多维运动并提供必要的力学支撑，以保护生命中枢脑干及周围血管、神经等重要结构。因小儿自我保护能力较差，各类严重创伤、畸形、肿瘤、结核、炎症等均可造成枕寰枢复合体区损伤。当损伤压迫延髓、颈髓、诸多神经、血管等危重情况时需手术矫治以恢复该区稳定，但鉴于0-6岁小儿有其不同于青少年和成人的发育特征，国内外学者对其前、后路手术内固定器械方案设计、矫形固定等至今仍无统一认识。因此本研究正是基于以上特点和需求，在前期研究基础上选取350例样本从宏观到微观多维度剖析0-6岁小儿枕寰枢复合体区形态发育特征及变化规律，通过对比和综合分析基础数据揭示其形态发生特征和力学机制。将丰富小儿颅颈交界区发育的形态学、影像学和结构力学数据库，并为发育性、外伤性颅颈交界区疾病的预防、诊治及内固定术器械设计、研发等提供理论依据。

本课题选取了320例0-6岁幼童枕寰枢复合体区样本，利用现代影像新技术（螺旋CT、MRI、Micro-CT）、计算机三维重建、有限元力学分析、硬组织包埋与组织切片等多种研究手段进行了系统探究，从宏观到微观多维度剖析枕寰枢复合体区形态发育特征，解剖毗邻关系及生物力学变化，提供了枕寰枢复合体及其颅底斜坡、寰枕关节、寰枢（正中、外侧）关节、枕骨大孔与枕髁及C1-C3关节突、椎弓根内固定术中前路和后路螺钉置入的进钉点、进钉方向、螺钉最佳直径及深度等相关数据；发现该区多处存在软骨结合、初级/次级骨化中心等。将实验结果与7-12岁、13-17岁及成人各相关参数对比分析，揭示其形态发生特征和力学机制。为该年龄段幼童枕颈区矫形仪、内外固定器、人工椎骨的设计与生产，人体工效学研究及该区与颈源性疾病的早期预防诊治等提供了理论依据、技术支持。为创建该龄段幼童颅颈钛合金板-螺钉内固定技术标准、理论依据和最佳方案积累了丰富实验数据，也为矫治幼童颅脑、上颈椎与颈髓创伤、畸形、结核、肿瘤等提供了基础理论依据。在已经完成的国内外首例5岁男童全身高精度薄层铣切断层解剖数据集基础上，重建了该儿童枕颈区各结构，以及脊柱、骨盆、肺脏、肝脏，肾脏等器官结构，得到了儿童各结构的关键数据、3D模型及儿童断层解剖图谱。课题研究具有创新性并按计划如期完成；发表相关学术论文20余篇，培养4名博士研究生，5名硕士生，出版主编专著、教材、图谱5部、参编2部，获得专利及软件著作7项，获得省级突出贡献奖、省级科研人才奖、教育部主编教材二等奖各1项，并创建了教育部高等学校医学人文素质教育基地。为从事基础、临床及数字转化应用的研究人员搭建了全新的科研、教学服务平台。