颈椎前路静力性与动力性钉板系统在三柱不稳定损伤中生物力学性能的比较  

Anterior Fixation for Cervical Distractive Flexion Injury:A Biomechanical Comparison of Rigidity after Fixation between Dynamic and Static Anterior Fixation

作　　者：樊健[1] 赵剑[2] 邵菁菁[1] 刘璠[2] 管国平[2] 邵云伟[1] 张辉[1] 王以进[3] 

机构地区：[1]江苏省启东市人民医院骨科,226200 [2]南通大学附属医院骨科 [3]上海大学生物力学工程研究所

出　　处：《中国骨与关节损伤杂志》2007年第4期265-267,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较颈椎前路静力性、动力性钉板系统在三柱屈曲牵张型不稳定损伤中的生物力学测试结果,为临床提供生物力学依据。方法采用6具小牛颈椎标本,在C4、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,分别测定正常颈椎及固定后脊柱在前屈、后伸、旋转运动时的稳定性并与正常标本比较。结果3种钢板固定后的活动度(ROM)与正常颈椎相比要大。其中Orion在前屈、后伸、侧屈与正常相比无显著的差异(P>0.05);Codman和Window在前屈、后伸时与正常相比有显著的差异(P<0.05);Codman在侧屈时正常相比无显著的差异(P>0.05),Window侧屈时与正常相比有显著的差异(P<0.05);3种钢板在旋转时与正常相比均有显著的差异(P<0.05)。结论在三柱屈曲牵张型不稳定损伤的模型中,前路静力化固定相对稳定,动力化固定可能降低一定的固定强度,尤其是选择平移类设计的钢板固定应慎重。Objective To compare the constructive stability with dynamic and static anterior cervical plates in 3 - column distractive-flexion injury model for providing the biomechanical basis for clinical application. Methods Six cadaveric calf spines were used in this test. After the distractive flexion injury models （C4,5） were established based on Allen＇s method, all specimens were discectomized, grafted and randomly divided into 3 groups using Orion, Codman, and Window instrumentation respectively. The stiffness of each construction was tested in flexion, extension, lateral bending and axial torsion condition sequentially. Results ROM of the construction with Orion, Codman and Window plate respectively were more than those of the intact spine specimens. There were no difference between the constructions with Orion plate and the intact specimens in flexion, extension and lateral bending. The construction with Codman and Window plate respectively provided less significantly stability than the intact specimens in flexion and extension （ P 〈 0.05 ）. There was significantly difference between the constructions with Codman and the intact specimens in lateral bending （P 〈 0.05 ）. The ROM of the construct with Window was similar to the intact specimens in lateral bending （ P 〉 0.05 ）. The construction with Orion, Codman and Window plate respectively provided less significantly stability than the intact specimens in axial ration （P 〈 0.05 ）. Conclusion Static fixation is the first choice for anterior fixation of cervical injuries. Dynamic plate may sacrifice some extent of stiffness when fixing traumatic cervical spine, especially for translational design.

关 键 词：颈椎 前路钢板 动力固定 生物力学 

分 类 号：R687.1[医药卫生—骨科学]