C1侧块C2椎板螺钉固定与C1-2关节螺钉固定的生物力学性能比较  

Biomechanical comparison between C1 lateral mass C2 crossing laminar screws fixation and C1-2 transarticular screw fixation

作　　者：黄师[1] 侯铁胜[1] 赵鑫[1] 贺石生[1] 

机构地区：[1]第二军医大学长海医院骨科,上海200433

出　　处：《中华实验外科杂志》2008年第12期1646-1648,共3页Chinese Journal of Experimental Surgery

摘　　要：目的比较C1侧块C2椎板螺钉固定与后路C1-2关节螺钉固定的生物力学性能，为枢椎交叉椎板螺钉的临床应用提供参考依据。方法收集新鲜成年人尸体颈椎标本（C0-C4）10具，男6具，女4具，平均年龄58岁（50～72岁）。分别制备成C1-2完整状态的模型（M0）、C1-2失稳的模型（M1）、C1侧块螺钉C2交叉椎板螺钉固定模型（M2）及后路C1-2关节螺钉固定模型（M3），进行三维生物力学测试，记录各组模型在屈伸、轴向旋转和侧屈的运动范围（ROM）和中性区（NZ）。结果屈伸模式下M0、M1、M2、M3的ROM和NZ分别为：（20．4±9．2）°、（10．4±5．8）°；（46．3±17．2））°、（34．5±14．1）°；（4．1±0．9）°、（1．9±0．8）°；（4．3±1．0）°、（2．1±0．7）°。轴向旋转模式下M0、M1、M2、M3的ROM和NZ分别为：（65．3±12．9）°、（40．8±11．2）°；（91．7±10．5）°、（72．3±12．6）°；（8．9±2．1）°、（4．7±1．8）°；（8．4±2．5）°、（4．4±2．3）°。侧屈模式下M0、M1、M2、M3的ROM和NZ分别为：（11．5±4．3）°、（7．2±3．2）°；（35．0±12．9）°、（21．9±11．8）°；（2．9±1．1）°、（1．4±0．8）°；（2．5±1．4）°、（1．3±1．0）°。在三维运动模式下M2和M3力学稳定性均明显优于M1和M0，然而M2和M3的差异无统计学意义（P〉0．05）。结论C1侧块C2椎板螺钉固定拥有良好的生物力学稳定性，可作为C1-2关节螺钉固定的良好替代。Objective To compare biomechanical stability between C1 lateral mass C2 crossing laminar screws fixation and C1-2 transarticular screw fixation. Methods Ten fresh adult cervical specimens （C0-C4） were obtained,of which 5 were male and four were female,and mean age was 58 years （50-72 years）. All specimens were made up into four different testing models such as C1-2 intact （M0 ） , C1-2 instability （ M1 ） ,C1 lateral mass and C2 crossing laminar screws fixation （ M2 ） and C1-2 transarticular screw fixation （ M3 ）, and then three-dimension biomechanical testing was performed. The range of motion （ROM） and natural zone （NZ） were recorded under flexion and extension, axial rotation and lateral bending motion. Results The ROM and NZ of M0,M1 ,M2 and M3 were （20.4 ±9.2）°,（10.4 ±5.8）°;（46.3 ± 17.2）°,（34.5 ±14.1）°;（4.1 ±0.9）°,（1.9 ±0.8）°;（4.3 ± 1.0）°,（2.1 ±0.7）° respectively under flexion and extension. The ROM and NZ of M0, M1, M2 and M3 were （ 65.3 ± 12.9） °, （40.8 ± 11.2） ° ; （91.7±10.5）°,（72.3±12.6）°;（8.9±2.1）°,（4.7±1.8）°;（8.4±2.5）°,（4.4±2.3）° respectively under axial rotation. The ROM and NZ of M0, M1 , M2 and M3 were （ 11.5 ± 4.3 ） °, （7.2 ± 3.2） ° ; （35.0±12.9）°,（21.9±11.8）°;（2.9±1.1）°,（1.4±0.8）°;（2.5±1.4）°,（1.3±1.0）° respectively under lateral bending. The stability of M2 and M3 was superior to M0 and M1 under three-dimensional biomechanical testing. However,the difference in stability between M2 and M3 had no significance （P 〉 0.05）. Conclusion C2 crossing laminar screws fixation has good biomechanical stability and is an alternative fixation of C2 pedicle screws.

关 键 词：枢椎 生物力学 内固定 

分 类 号：R687.3[医药卫生—骨科学]