斜坡固定钢板行前路枕颈固定的生物力学研究  

A clival-cervical plate fixation for the craniovertebral instability:a biomechanical study

作　　者：季伟[1] 黄志平[1] 李若瑶 张泽帆 黄祖成[1] 吴秀华[1] 张忠民[1] 朱青安[1] Ji Wei;Huang Zhiping;Li Ruoyao;Zhang Zefan;Huang Zucheng;Wu Xiuhua;Zhang Zhongmin;Zhu Qing'an(Division of Spine Surgery,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;The First Clinical Medical College,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院骨科学-脊柱骨科,广州510515 [2]南方医科大学第一临床医学院,广州510515

出　　处：《中华骨科杂志》2022年第11期722-729,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82172523);广东省自然科学基金(2022A1515010488)

摘　　要：目的研制一种用于枕颈不稳行前路枕颈固定的斜坡固定钢板,并与后路枕颈固定方法进行生物力学稳定性对比分析。方法对40具成人颅颈段干骨和30例健康志愿者颅颈段CT扫描图像进行相关参数测量,以此为基础研制斜坡固定钢板。采用8具新鲜成人颈椎(C_(0)~C_(3)节段)模拟以下状态后进行生物力学测试:①完整状态;②完整状态+斜坡固定钢板固定(前路行斜坡至C_(2)固定);③损伤状态;④损伤+斜坡固定钢板固定;⑤损伤+后路枕颈固定(后路行枕骨板钉、C_(1)和C_(2)椎弓根螺钉固定)。采用重复测量的实验设计,在完整、损伤和不同固定状态下,通过脊柱试验机对标本分别施加1.5 N·m屈伸、侧弯和轴向旋转的纯力偶矩。在枕骨、C_(1)和C_(2)椎体上连接固定红外线标志点,采用Optotrak三维运动测量系统连续采集标志点运动,分析C_(0)~C_(2)节段间角度运动范围(range of motion,ROM)和中性区(neutral zone,NZ)。比较不同的固定方式对枕颈区各节段ROM分布的影响。结果损伤+斜坡固定钢板固定后C_(0)~C_(2)节段ROM为前屈1.7°、后伸1.2°、侧弯2.8°、旋转4.3°,较损伤+后路枕颈固定状态在前屈(q=4.68,P=0.055)、后伸(q=0.39,P=0.992)以及侧弯(q=1.25,P=0.814)方向的差异无统计学意义,而在旋转方向上活动范围更大(q=5.08,P=0.035)。以上两种固定状态下在屈伸(q=1.94,P=0.554)、侧弯(q=1.79,P=0.611)及旋转(q=2.14,P=0.478)方向NZ的差异均无统计学意义。在前屈、后伸、侧弯及旋转方向上,损伤+斜坡固定钢板状态下C_(1,2)节段ROM占总体C_(0)~C_(2)ROM比例分别为28%、25%、34%和56%,而损伤+后路枕颈固定状态下其占比分别为59%、53%、42%和71%。结论斜坡固定钢板固定能提供较好的枕颈区力学稳定性,可作为枕颈区不稳的一种可选择内固定方法。Objective To develop a specialized clival-cervical plate fixation(CCPF)for anterior surgery to treat craniovertebral instability,and to compare it with a posterior occipitocervical fixation(POCF)in biomechanical validation.Methods Based on the measurement of 40 adult dry bones and 30 volunteers CT images,the clival-cervical plate was designed and manufactured.8 cadaveric specimens(occiput-C_(3))were tested in five conditions including the intact status,the intact+CCPF status,the injury status,the injury+CCPF status,and the injury+POCF status.Specimens were applied a pure moment of 1.5 N·m in flexion,extension,lateral bending,and axial rotation.Calculating and comparing the range of motion(ROM)and neutral zone(NZ)for the occiput to C_(2).The effects of different fixation methods on the distribution of ROMs at the occipitocervical region were compared.Results The injury+CCPF status constrained ROMs to 1.7°in flexion(q=4.68,P=0.055),1.2°in extension(q=0.39,P=0.9922),2.8°in lateral bending(q=1.25,P=0.814),and 4.3°in axial rotation(q=5.08,P=0.035),resulted in larger ROM in axial rotation but similar ROMs in other directions(P>0.05)when compared with the injury+POCF status.There were no significant differences between the above two fixation methods in flexion-extension(q=1.94,P=0.554),lateral bending(q=1.79,P=0.611)and axial rotation(q=2.14,P=0.478)for the NZs.For the flexion,extension,lateral bendingand axial rotation direction,the proportion of the C_(1,2)ROM to the overall ROM was 28%,25%,34%and 56%respectively in the injury+CCPF status,and it was 59%,53%,42%and 71%respectively in the injury+POCF status.Conclusion CCPF is a biomechanically effective alternative or supplemental method of POCF for the craniocervical instability.

关 键 词：寰枕关节 颅窝 后 脊柱融合术 生物力学现象 

分 类 号：R687.3[医药卫生—骨科学]