不同类型前路钢板固定应用于颈椎屈曲牵张型损伤的生物力学研究  

Anterior plate fixation for cervical distractive flexion injuries:a biomechanical comparison of different types of design

作　　者：赵剑[1] 吴红富[1] 管国平[1] 施红光[1] 刘璠[1] 樊健[1] 王友华[1] 

机构地区：[1]南通大学附属医院骨科,226001

出　　处：《中华创伤骨科杂志》2006年第6期553-556,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用前路钢板固定颈椎屈曲牵张型损伤治疗的可靠性,并比较静力化固定和动力化固定等不同设计类型钢板在恢复损伤节段稳定性方面的差异。方法采用12具小牛颈椎标本,在C_(4,5)节段制作屈曲牵张损伤模型,切除椎间盘、植骨后随机分为3组,分别采用Orion、Codman、Window钢板、螺钉固定,测试手术固定各组在颈椎前屈、后伸、侧屈及旋转运动时的稳定性并与正常标本比较。结果颈椎屈曲损伤后,无论采用哪种钢板固定,其术后运动范围(ROM值)均比正常颈椎要大。Orion固定最接近正常标本,但在旋转运动时有明显差异。Codman固定仅在侧曲时的稳定性接近正常和Orion固定组。Window固定最弱,在各运动状态下的刚度均明显低于正常组。结论在颈椎屈曲牵张型损伤时,前路静力化固定相对稳定,动力化固定可能牺牲一定的固定强度,尤其是选择平移类设计的钢板固定更要谨慎。Objective To evaluate the safety of dynamic anterior plate fixation for cervical distractive flexion injuries and compare its rigidity between different types of plate design. Methods Twelve sets of cadaveric calf spine were used in this test. All the specimens were made into distractive flexion injury models （C4-C5） according to Allen＇ s method. After discectomy and grafting, they were randomized into three groups in which Orion, Codman, and Window instrumentations were used respectively. The stiffness of each construct was tested in flexion, extension, lateral bending and axial torsion conditions sequentially. Results Compared with an intact cervical spine, the range of motion （ROM） of an injured cervical spine increased whatever plate was applied. Orion instrumentation presented stiffness the closest to that of the normal control, except for less torsional stiffness. Codman instrumentation provided stiffness close to that for normal and Orion groups only in lateral bending. Window＇s was the weakest and not enough in all kinds of movement. Conclusions Static anterior fixation is the first choice for cervical injuries. Dynamic plate fixation may sacrifice stiffness to some extent, especially when a shifting kind of design is to be chosen.

关 键 词：颈椎 前路钢板 动力同定 生物力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]