Department of Orthopaedics, Beijing Sino-Japanese Friendship Hospital, 100029, Tan Mingsheng, Wang Onion, Wang Yunting, Ping Ping, Wei, Yu Yang, Zhang Guang, Li Zirong, The purpose of the study is to provide data on the sacral vertebrae of the Chinese sacral spine. feasibility. Methods The vernier caliper and protractor were used to measure the parameters of the posterior arch entry point and the direction of the nail in 50 dry sacral specimens. RESULTS: The axial length of the posterior arch screw channel of the posterior arch of the atlantoaxial arch of the atlas and the parameters of the posterior arch entry point and the direction of the nail were measured. Conclusion The atlas has the condition of internal fixation of the posterior arch of the posterior arch.
The common internal fixation of the upper cervical vertebrae includes 0 sen 6 wire 8 clips 4 through the articular process screw fixation and other techniques, with fixed segments. Short, retaining the advantages of the occipital joint function, but all have different degrees of internal fixation stability, prone to loosening of the internal fixation, bone grafting is not integrated. The reliable effect of thoracolumbar pedicle screw fixation in the stability of spinal fixation has been agreed. In order to explore the possibility of internal fixation of the posterior arch of the atlantoaxial arch, and to provide anatomic basis for the screw design and operation, the author measured the posterior arch of the sacral vertebrae, focusing on the posterior arch of the atlas. A preliminary study was conducted on the nail direction.
Materials and Methods Specimens and gauges 50 adult dry vertebral vertebrae, gender age unknown. The measurement uses the precision of domestic vernier calipers. Professor Tan Mingsheng is mainly engaged in spine surgery. He has presided over 3 national and provincial scientific research courses, mainly participated in 3 national and provincial scientific research courses, and won 6 invention patents for orthopedic medical devices.
02 and protractor accuracy 0.1.
Measurement content and method 1 The nail channel and the nail point and the intersection of the vertebral artery sulcus to the coronal plane at the lower edge of the posterior arch are the nail channel; the nail channel is in the posterior arch posterior cortex The projection point on the point is the entry point, and the distance between the person point and the lower edge of the rear bow is measured, and the distance between the incision of the outer edge of the rear bow and the distance between the left and right nail points. The posterior arch measurement includes the posterior arch height 7 and the posterior arch width at the entry point, and the posterior arch outer diameter at the bottom of the vertebral artery sulcus is 1 OD wide, the inner diameter is high, and the inner diameter is 2. The inner diameter is high. The measurement of the inner diameter is required to be performed after the other measurements are completed, and the posterior arch of the vertebral artery sulcus at the bottom of the vertebral artery can be performed. 3 The lateral distance between the inner side wall of the transverse hole and the inner edge of the side block is the lateral diameter of the side block; the vertical distance between the outer point of the outer edge of the upper and lower joint surface and the inner edge is the intermediate degree of the side block. . 4 The measurement of the direction of the nail in the direction of the posterior axis of the posterior arch is spaced from the leading edge of the vertebral artery, and the distance from the leading edge of the lateral block is from the width of the vertebral artery.
5 The measurement of the half distance of the vertebral artery groove includes the inner half and the outer half. The angle of the anterior medial edge of the vertebral artery sulcus from the midline of the posterior arch is the angle between the direction of the nail and the sagittal plane of the sagittal plane.
Results The statistical data of the data were all ±±standard deviation±8, and the difference between the two groups of data was compared by 1 test.
There is no significant difference between the measurement point of the entry point and the left and right sides of the posterior arch, 0.05; the difference between the point and the outer edge of the posterior arch is larger; the distance between the left and right insertion points is 38.06±3.781. The nailing point is about 1820 next to the midline and 2 points above the lower edge of the posterior arch. The average of the incision from the outer edge of the posterior arch is about 2.5 stomach. The posterior arch measures the posterior arch height at the thinnest part of the vertebral artery sulcus at the thinnest part of the vertebral artery. It is also smaller than the posterior arch width at the entry point. The posterior arch is the diameter of the inserted screw and the operation. the key to success. The diameter of the left side of the outer diameter of this design can be 2.73.03.5. The lateral block measurement side block is relatively large relative to the posterior arch, similar to other cervical vertebrae. The width of the vertebral artery groove on the axis of the posterior arch side block is about 9.5, and the point is about 10.5 with the leading edge of the vertebral artery groove. The distance between the person point and the leading edge of the side block is about 30. According to the length of the screw, 24. During the operation, special attention should be paid to the placement of the screw at the beginning of the nail path. In the direction of the nail, the difference between the left and right is not obvious. The coronal plane is kept substantially vertical, and the nail head on the sagittal plane is inclined to the head side by about 5.
After the posterior arch is smeared, the outer diameter of the bow is high. The inner diameter of the posterior arch is high. The inner diameter of the posterior arch is wide and the outer diameter of the arch is wide. The distance between the entry point and the lower edge of the posterior arch is smaller than that of the posterior arch. The distance between the middle point of the block and the anterior edge of the vertebral artery is the distance between the nail point and the side of the side block. The distance from the vertebral artery groove width to the medial half of the gastric vertebral artery sulcus The distance is compared with the data of the left and right groups from all the measured indicators, 5.30.
Discussion on the feasibility of the application of the posterior arch of the atlas of the atlas. The sacral joint connects the skull and the cervical vertebra, which is the corresponding part of the life center of the spinal cord, and its anatomical location is dangerous. Therefore, when the atlantoaxial dislocation or the occipital sac is unstable, the medulla can be directly compressed, endangering the patient's life. Therefore, the effective fixation of the atlas is essential. At present, the study suggests that the cervical pedicle screw fixation technique is superior to other conventional anterior cervical posterior fixation and anterior and posterior fixation methods in biomechanical stability. Compared with other posterior fixation methods of 02, including 0, de-8, and 18 wire fixation and 8 laminar clip fixation, the atlantoaxial transarticular screw fixation technique introduced by 1 and 566 is stronger. Biomechanical stability. However, this procedure has no advantage in resisting axial displacement. Therefore, the above several methods can not achieve a firm fixation effect, and it is necessary to add a stronger external fixation before the bone grafting, such as 10 frames. The author through the anatomical observation of the atlas, found that if the posterior arch at the vertebral artery is regarded as the pedicle of other spine, and the lateral block as the vertebral body, the posterior arch of the atlas is also the same It can be similar to pedicle screw fixation.
According to the method described in the paper, the length of the nail path was found to be from about 30. The coronal plane, the width of the posterior arch and the width of the lateral block at the vertebral artery groove were large, and the condition of the screw was placed; and the sagittal plane, the vertebral artery groove The height of the posterior arch is smaller than the width of the posterior arch and the posterior arch at the entry point, which increases the difficulty and danger of the insertion of the screw, but the outer diameter is greater than 4 and the inner diameter is also Around 2.0, it has the condition of inserting a screw with a length of 24 and a diameter of 3 or so. Screws can be designed in several sizes to suit individual needs. Based on the results of bone measurement, 5 patients in the clinic were operated on the radiology before and after surgery. The results showed that the screw channel and the bone measurement were the same. Therefore, the author believes that the atlas has the conditions for internal fixation of the posterior arch of the posterior arch.
The anatomical features of the vertebral artery sulcus and posterior arch are more anatomical. Among the 100 vertebral arterial sulcus measured in this lesson, the pattern was shallow side of 83 sides, 7 sides of deep groove, 2 sides without groove; 8 sides of grooved ring appeared, and 2 sides of full ring groove appeared. Semi-ring groove ring 6 side. There is also a large difference in the outer edge of the superior arch of the posterior arch behind the vertebral artery sulcus. Among them, 7 cases of 10 sides of the outer edge of the notch are not obvious, it is difficult to grasp when measuring. In contrast, the lower edge of the posterior arch behind the vertebral artery sulcus is relatively flat and has little variation. It can be used as the nail point and the direction of the nail insertion. The outer edge of the posterior arch of the posterior arch is behind the vertebral artery groove. There is a big difference, which is difficult to be used as a bone marker to determine the entry point. The posterior arch lower edge and the posterior arch nodule posterior point behind the vertebral artery groove can be selected as a marker for positioning the point of the nail. The position of the nail on the posterior arch is 1820 next to the midpoint of the posterior tibial tuberosity, and the intersection of the lower edge of the posterior arch is 21 upwards. Studying the adjoining relationship of the posterior arch of the atlas, it is known that the vertebral artery penetrates the transverse sulcus and then straddles the vertebral artery sulcus into the cranial cavity. The outer edge of the posterior arch has a vertebral venous plexus, and the occipital large nerve is bypassed below. Central. Therefore, the nailing direction should be strictly controlled when placing the nail. The results of this study suggest that the posterior arch side screw maintains the vertical nail in the coronal plane, and the head end of the sagittal plane is inclined toward the head side by about 5, which can basically ensure the accuracy of the nail placement. However, attention should be paid to the individualized operation because there are anatomical differences between individuals in the posterior arch side block. The lateral position of the atlas, the piece and the 01 piece have a certain meaning for determining the entry point and the direction of the nail.
Determination of the scope of surgical exposure and the access to the nail channel The measurement of the radius of the vertebral artery sulcus found that the medial and lateral half distances were relatively constant, with the medial half-range being approximately 13 and the lateral half-distance being approximately 24. The nail channel is recommended in the vertebral artery sulcus, the middle of the posterior arch 13, which is about 1820 round from the midline, which can ensure strong fixation without damage to the vertebral artery in the vertebral artery and the medulla in the spinal canal. This value corresponds to the measured distance between the entry point and the center line. Therefore, the intraoperative posterior arch stripping radius should be held in 2 alone. The left anatomy of the sacral vertebrae in this class shows that the atlas has the condition of placing the posterior arch side block screw. For the clinical teaching and research, the relevant data of the Chinese sacral vertebrae are provided, and it is considered that the pedicle screw fixation technique of the posterior arch of the atlas is feasible. However, due to the unclear age and gender of the bone specimens measured, the statistics of the bone specimens are limited, and the relevant anatomical materials for mechanical testing of surgical indications have been studied. Received on 2002, 129, on page 28, puts forward the policy recommendations for medical care and care facilities for the elderly in Beijing that meet the national conditions. The basic concept is based on government policies and regulations, based on community services, relying on family support, strengthening the awareness of self-care for the prevention of disease among the elderly, advocating the independence of the elderly and actively participating in society. Promoting a healthy lifestyle and doing a good job in the prevention and treatment of chronic diseases in the elderly can not only prolong the labor period of the elderly, but also alleviate the reduction of labor resources caused by the aging of the population in the future. At the same time, it can promote the longevity of the elderly and prolong the life of the elderly and reduce the elderly. The investment in medical care and care is aimed at achieving the goal of healthy aging.
This course was funded by the United Nations Development Programme and won the Beijing Science and Technology Progress Award. Received 20001001
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