摘要
目的评价枕颈部经关节螺钉内固定重建枕寰枢复合体稳定性的生物力学性能。方法选择12例新鲜尸体枕颈部标本,在标本完整状态(intact组)、枕寰枢失稳模型(destab lized组)、枕颈部植骨块附加钛缆捆绑固定(cab le+graf组)、枕颈部经关节螺钉固定(CTS组)、SUMM IT枕颈部内固定系统固定(SUMM IT组)、经关节螺钉附加植骨块(CTS+graft组)以及SUMM IT附加植骨块(SUMM IT+graft组),共7种状态下,依次用脊柱三维运动测量系统测试其Oc-C1、C1-C2节段的运动参数,并行统计学分析。结果CTS组各方向运动的运动范围(ROM)和中性区(NZ)均明显小于cab le+graf组(6.64°±0.59°、2.49°±0.26°、0.50°±0.03°、0.21°±0.01°、0.27°±0.07°、0.13°±0.01°vs 10.01°±1.26°、3.80°±0.79°、7.93°±1.34°、3.18°±0.95°、9.54°±0.87°、5.93°±0.74,°P<0.05),CTS组在C1-C2节段旋转运动的ROM和NZ均显著小于SUMM IT组(1.64°±0.39°、0.61°±0.15°、0.14°±0.05°、0.02°±0.01°、0.32°±0.04°、0.08°±0.01°、vs 0.21°±0.04°、0.07°±0.03°、0.21°±0.12°、0.10°±0.02°、2.92°±0.28°、1.27°±0.11°,P<0.05)。结论枕颈部后路经关节螺钉内固定在重建枕寰枢力学稳定性有其独特的优点,尤其在控制旋转和侧屈的稳定性上,可有力地促进局部的植骨融合。
Objective To evaluate the stability of biomechanics of occipitoatlantoaxial reconstruction with transarticular screw fixation. Methods Twelve fresh human cadaveric occipitocervical spine specimens were mounted in a custom-designed, spine -testing machine that applied pure moments while recording the three-dimensional angular movement at occiput （Oc）-C1 and C1-2 segments. The specimens were tested under seven different conditions ： the intact （ intact group）, the occipitoatlantoaxial instability （ Destabilized group）, fixation with Ti-cable plus bone graft group （ cable ＋ graf group）, fixation with the transarticular fixation （CTS group）, fixation with SUMMIT occitocervical spinal fixation system （SUMMIT group）, fixation with transarticular screw plus bone graft （CTS ＋ graf group）, and fixation with SMMIT system and plus graft group （ SUMMIT ＋ graf group）. The data obtained were statistically analyzed. Results The CTS group reduced motion to well within the normal rang. In the Oc-C1 segment, The CTS group and SUMMIT group allowed a very small rang of motion（ROM） and neutral zone（NZ） during lateral bending and axial rotation. The ROM and NZ during flexion and extension of the SUMMIT group, were significantly smaller than those of cable ＋ graf group and CTS group （6.64° ± 0.59° ,2.49°± 0. 26° ,0.50° ± 0.03° ,0.21°±0.01° ,0.27°± 0.07° ,0.13°± 0.01°vs 10.01° ± 1.26° ,3.80° ± 0.79° ,7.93° ± 1.34°, 3. 18°±0.95°,9.54° ±0.87°,5.93° ±0.74°,P〈0.05）. In the C1-2 segment, ROM and NZ in all directions of CTS group were smaller in rotation than SUMMIT group （ 1. 640 ±.39° ,0.61°±0. 15° ,0.14° ±0.05°,0.02°±0.01°,0.32° ±0.04°,0.08° ±0.01°,vs 0.21° ±0.04°,0.07° ±0.03°,0.21°±0. 12°, 0. 10°±0.02° ,2.92° ± 0.28°, 1.27°± 0.11°, all P 〈 0.05 ）. There was no significant difference in ROM and NZ in all directions between CTS ＋ graf group and SUMMIT ＋ Graf group （ P 〉 0.05 ）. Conclusion In vivo biomechanics studies show that posterior occipitocervical transarticular fixation has unique features in reconstructing dynamic stability of the occipitoatlantoaxis, especially in controlling stability of rotation and lateral flexion, thus ensuring successful fusion of the implanted bone and allowing for clinical use of the technique.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第13期872-875,共4页
National Medical Journal of China
关键词
寰枢关节
内固定器
脊柱融合术
Atllanto-axial joint
Internal fixators
Spinal fusion
