使用患者特异性CNC铣削钛植入物对犬不稳定枕骨髁骨折进行手术治疗：一例病例报告。

文献信息

中文摘要

一只10岁去势雄性博美犬在跌倒后接受评估，表现为四肢轻瘫、吞咽困难和头偏斜。磁共振成像（MRI）显示右侧枕骨髁骨折，导致脑干受压，并因移位的骨碎片引起小脑梗死。根据人类医学中的Anderson和Montesano分类，该病例被推测为3型，提示不稳定，因此考虑手术矫正。位于延髓的骨碎片因切除可能带来严重并发症风险而留置原位。为预防不稳定造成进一步损害，实施了枕颈稳定手术。通过CAD设计并由CNC铣削制造了患者特异性钛植入物，使用标准技术将螺钉应用于枕骨和C1椎体，同时将一枚螺钉横向插入C2棘突，以尽量减少颈部屈曲导致植入失败的风险。术后计算机断层扫描（CT）确认植入物位置正确，无神经损伤。随着时间推移，患者舌下功能障碍和步态均有改善，并于术后第5天出院。枕骨髁骨折在兽医和人类医学中均属罕见，大多数病例被归类为1型或2型，通常不需要手术干预。据我们所知，这是首篇经同行评审的描述使用患者特异性、CNC铣削钛植入物对犬枕骨髁骨折进行手术稳定的报告。枕骨髁骨折的保守治疗以及颅颈交界区骨折的手术稳定此前已有描述，本报告的贡献在于植入物设计与制造流程，而非颅颈损伤本身的手术管理。

英文摘要

A 10-year-old castrated male Pomeranian was evaluated after a fall and presented with tetraparesis, dysphagia, and headturn. Magnetic resonance imaging (MRI) revealed a right occipital condyle fracture that caused brainstem compression and cerebellar infarction from a displaced bony fragment. According to the Anderson and Montesano classification in human medicine, this case was presumed to be Type 3, indicating instability, and surgical correction was considered. A bone fragment located in the medulla oblongata was left in situ owing to the potential risk of severe complications from removal. Occipitocervical stabilization surgery was performed to prevent further damage from instability. A patient-specific titanium implant was designed by CAD and fabricated by CNC milling, and screws were applied to the occiput and C1 vertebra using standard techniques, whereas a screw was inserted transversely into the C2 spinous process to minimize the risk of implant failure from neck flexion. Postoperative computed tomography (CT) confirmed proper implant placement without neural injury. Over time, the patient showed improvements in hypoglossal dysfunction and gait, and was discharged on postoperative day five. Occipital condyle fractures are rare in both veterinary and human medicine, with most cases classified as type 1 or 2, and typically do not require surgical intervention. To the best of our knowledge, this is the first peer-reviewed description of surgical stabilization of an occipital condyle fracture in a dog using a patient-specific, CNC-milled titanium implant. Conservative management of occipital condyle fracture and surgical stabilization of craniocervical junction fractures have been described previously, and the contribution of the present report lies in the implant design and fabrication workflow rather than in the surgical management of craniocervical injury per se.