经小关节螺钉固定术与多轴螺钉钉杆系统行后路寰枢椎内固定的生物力学比较研究  

Biomechanical study of posterior atlantoaxial fixations:transarticular fixation and polyaxial screws and rods construct fixation via C_1 lateral mass and C_2 pedicle

作　　者：王永庆[1] 田伟[1] 

机构地区：[1]北京积水潭医院,北京100035

出　　处：《山东医药》2010年第28期8-11,共4页Shandong Medical Journal

摘　　要：目的研究经小关节螺钉寰枢椎内固定和多轴螺钉系统经寰椎侧块、枢椎椎弓根寰枢椎内固定的稳定性。方法取新鲜青年男性上颈椎(C0～C4)12例,制成骨韧带标本,随机均分为3组,分别进行3种不同的内固定后测量C1/C2间的相对转动位移量。完全复位组进行C1/C2完全复位状态下的Magerl+Brooks术,未完全复位组在C1/C2未完全复位时行Magerl+Brooks术,多轴螺钉组使用多轴螺钉系统行经C1侧块、C2椎弓根固定。对固定标本进行轴向旋转疲劳循环载荷后再行测量。进行活动度比较。结果 Magerl术在加用Brooks固定前后C1/C2各方向的活动度均减少(P<0.05),而Magerl+Brooks术在疲劳循环载荷前后C1/C2间活动度无统计学差异。多轴螺钉固定在各方向的活动度较双侧经关节螺钉固定小,且在前屈—后伸的方向上有统计学差异;比Magerl+Brooks固定的活动度大,但差异无统计学意义。在疲劳载荷后,多轴螺钉固定的活动度增大,在前屈后伸和轴向旋转方向上有统计学差异;与Magerl+Brooks固定疲劳循环载荷后的活动度亦有统计学差异。结论 C1/C2完全复位与否对Magerl+Brooks固定的稳定性无影响,C1/C2双侧经关节螺钉固定在加用Brooks固定后稳定性增加显著。C1/C2多轴螺钉固定比双侧经关节螺钉固定更为稳定。C1/C2多轴螺钉即时固定稳定性与Magerl+Brooks相近,但在多次疲劳循环载荷后显著下降,弱于Magerl+Brooks疲劳载荷后。Objective To evaluate and compare the stability of two posterior atlantoaxial fixation： transarticular fixation and polyaxial screw fixation via C1 lateral mass and C2 pedicle.Methods A total of 12 fresh-frozen young human cadaveric upper cervical spine（C0-C4） were used and divided into 3 groups randomly.All specimens were tested and the rotation range of motion between C1 and C2 was measured.The 4 specimens in group 1 were fixed with Magerl＋Brooks technique,with C1/C2 aposited completely.Group 2 were also fixed with Magerl＋Brooks,but a 2 to 3 mm C1 anterior dislocation remained.The specimens in group 3 were implanted with the polyaxial screws and rods construct,in which the screws were in the C1 lateral masses and C2 pedicles.Fatigue axial-rotation cycles were applied to each fixed specimens,then the specimen were tested as the last time.Range of rotation data were normalized to the data of the destabilization.Results With Magerl＇s fixation,range of motion between C1 and C2 was reduced significantly in every direction after Brooks wiring（P〈0.05）.The range of motion between C1/C2 with Magerl＋Brooks fixation was not changed significantly after the fatigue cycles.The range of motion with polyaxial screw fixation was smaller than that with bilateral transarticular screw fixation and statistical significance was shown in flexion-extension.The range of motion with Magerl＋Brooks fixation was smaller than that with polyaxial screw fixation,but there was no statistical significance.The range of motion with polyaxial screw fixation increased significantly in flexion-extension and axial rotation after fatigue cycles,furthermore there was statistical difference between the range of motion with polyaxial screw fixation after fatigue cycles and that with Magerl＋Brooks fixation.No statistical difference was shown between the acute range of motion with bilateral transarticular screw fixation and that with polyaxial screw fixation after fatigue cycles.Conclusions Weather the dislocation of C1 and C2 is co

关 键 词：寰椎 枢椎 生物力学 内固定器 

分 类 号：R683.2[医药卫生—骨科学]