摘要
目的:评价寰枢椎后路四种不同钉棒固定方法的生物力学稳定性。方法:6具人体新鲜颈椎标本,切除齿状突及寰枢间韧带等结构制造寰枢椎失稳模型,对每具标本先后进行5种方式固定:A组(双侧C1椎弓根螺钉+C2/3经关节螺钉)、B组(C1椎弓根螺钉+C2侧块螺钉)、C组(C1椎弓根螺钉+C2椎弓根螺钉)、D组(C1椎弓根螺钉+C2椎板螺钉);与对照组E组(Magerl螺钉,即经C1/2侧块关节螺钉)进行对比,在脊柱三维运动实验机上测量比较其寰枢椎间的屈伸、侧屈、旋转三维稳定性。结果:在前屈稳定性上,四种钉棒固定方法(A、B、C、D组)间无差异(P>0.05),且均优于单纯Magerl螺钉固定(E组)(P<0.05)。在后伸稳定性上,D组与E组两种固定方法间无差异(P>0.05),其抗后伸的稳定性较A、B、C组略差(P<0.05);A、B、C组三种钉棒固定方法间无差异(P>0.05)。在侧屈运动稳定性上,D组的稳定性略差,其他四种固定方式间无差异(P>0.05)。在旋转稳定性上,所有固定方式间无统计学差异(P>0.05)。结论:四种钉棒固定方法都具有可靠的三维稳定性,临床应用时可以根据患者的个体解剖结构情况和术者对不同手术技术的熟悉程度进行选择。
Objective：To evaluate the biomechanical stability of four different C1-C2 screw-rod fixation techniques for atlantoaxial instability.Method：Six cervical fresh specimens were harvested to create the atlantoaxial instability model,the specimens were tested in the following order：group A（C1 pedicle screw＋C2/3 transarticular screw rods fixation）,group B（C1 pedicle screw＋C2 lateral mass screw rods fixation）,group C（C1 pedicle screw＋C2 trans-laminar screw rods fixation）,group D （C1 pedicle screw＋C2 pedicle screw rods fixation）.The 3D biomechanical stability of atlantoaxial segments were measured and compared with group E（Magerl screws） as a control.Result：In flexion direction,stability of all four screw-rod atalantoaxial fixation techniques signifi- cantly increased as compared with Magerl screw fixation technique（P〈0.05）.In extention direction,except group D which was equivalent to group E, stability of the other three screw-rod atalantoaxial fixation techniques was superior than that of group E （P〈0.05）.In lateral bending direction,the stability of group D was less than group E＇s,but,the stability of other three screw-rod atalantoaxial fixation techniques was equivalent to that of group E.There was no statistical difference among all the five fixation techniques for the rotation stability （P〉 0.05）.Conclusion：Each screw-rod combination of four posterior C2 fixation methods plus C1 pedicle screw has a satisfied biomechanical stability.These four screw-rod fixation methods should be clinically selected based on the individual anatomy of the patients and the operative skill of each surgeon.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第6期464-468,共5页
Chinese Journal of Spine and Spinal Cord
基金
广东省医学科研基金项目(A2005503)
广东省自然科学基金团队项目(20023001)
关键词
寰枢椎
螺钉
内固定
生物力学
Atlantoaxial joint
Screw
Internal fixation
Biomechanics
作者简介
男（1970-），副主任医师，医学博士后，研究方向颈椎损伤的临床与解剖研究电话：（020）36653535 E—mail：maxy1001@126．com
