上颈椎结构损伤对C1～C2和C2～C3节段稳定性影响的生物力学研究  

Biomechanical study on effect of upper cervical spine structural injury on stability of C1-C2 and C2-C3 segments

作　　者：胡勇[1] 董伟鑫[1] 袁振山[1] 孙肖阳[1] 张蛟[1] 

机构地区：[1]宁波大学医学院附属宁波市第六医院脊柱外科,315040

出　　处：《中华创伤杂志》2015年第4期360-365,共6页Chinese Journal of Trauma

摘　　要：目的测试Ⅱ型齿状突骨折、I型Hangman骨折及C2～3椎间盘损伤对C1～C2节段和C2～C3节段稳定性的影响并探讨其临床意义。方法新鲜成人完整C1～C3标本10具，男5具，女5具；年龄25—45岁，平均35．7岁。在生物力学试验机上依次按照对照组（正常状态）、I型Hangman骨折组、Ⅱ型齿状突骨折组、I型Hangman骨折＋Ⅱ型齿状突骨折组、I型Hangman骨折＋Ⅱ型齿状突骨折＋C2～3椎间盘损伤组顺序测试C1～C2及C2～C3节段的三维运动范围（ROM）及中性区（NZ），对结果进行统计学分析。结果I型Hangman骨折组与对照组比较，ROMC1-C2在各方向上差异均无统计学意义，且ROMC2-C3的左／右侧屈两个方向上差异亦无统计学意义；Ⅱ型齿状突骨折组与对照组比较，ROMC2-C3在各方向上差异均无统计学意义，且ROMC1-C2的左／右旋转两个方向上差异亦无统计学意义；I型Hangman骨折＋Ⅱ型齿状突骨折组和对照组比较，ROMC1-C2值只在左／右旋转方向上以及ROMC2-C3值只在后伸方向上差异无统计学意义。I型Hangman骨折＋Ⅱ型齿状突骨折＋C：～。椎间盘损伤组与对照组比较，ROM。，～。值在侧屈和前屈后伸方向上以及ROM。。值在各方向上差异均有统计学意义（P〈0．05）。结论I型Hangman骨折丧失了C2～C3节段在左／右旋转和前屈后伸方向的稳定性，Ⅱ型齿状突骨折丧失了C1-C2节段在左／右侧屈和前屈后伸方向上的稳定性；I型Hangman骨折伴Ⅱ型齿状突骨折联合C2-3，椎间盘损伤丧失了除寰枢关节旋转功能外C1-C3节段所有方向的稳定性。本研究可为相关内固定技术的研究和临床治疗提供生物力学依据。Objective To evaluate the effect of type Ⅱ odontoid fracture, type I Hangman frac- ture, C2-C3 disc injury on stability of C1 -C2 and C2-C3 segments and investigate the clinical significance. Methods Ten fresh-frozen eadaverie cervical specimens （5 men and 5 women; 25 -45 years of age, mean 35.7 years） were selected to test the stability of Cl-C2 and C2-C3 segments in the settings of intact condition （control group） , type I Hangman fracture, type II odontoid fracture, type I Hangman fracture ＋ type Ⅱ odontoid fracture, type I Hangman fracture ＋ type I1 odontoid fracture ＋ C2-C3 disc injury. Range of motion （ROM） and neutral zone （NZ） of those segments were measured. Results Compared with the intact condition, type I Hangman fracture produced no significant variations in C1 -C2 ROM in all load- ing modes and C2-C3 ROM during left and right lateral bending; type Ⅱ odontoid fracture produced no significant variations in Cz-C3 ROM in all loading modes and CI-C2 ROM during left and right rotation; type I Hangman fracture ＋ type Ⅱ odontoid fracture revealed no significant variations in C1-C2 ROM dur-ing left and right rotation and C2-C3 ROM during extention; type 1 Hangman fracture ＋ type Ⅱ odontoid fi＇acture ＋ C2-C3 disc injury produced no significant variations in CI -C2 ROM dr,ring left and right lateral bending and exlension-flextion anti C2-C3 ROM in all loading modes （P 〈0.05）. Conclusions Type I Hangman fracture can reserve C1-C2 segmental left and right rotation and extension-flextiun; type Ⅱ odontoid fracture can reserve C1-C2 segmental left and right lateral bending and extension-flextion; type I Hangman fracture ＋ type Ⅱ odontoid fracture ＋ C2-C3 disc injury can reverse atlantoaxial rotationary stability and C1-C3 segmental stability in all directions. This study provides the biomechanical basis for clinical Ireatments and the related researches of internal fixation.

关 键 词：颈椎 脊柱骨折 椎间盘 生物力学 

分 类 号：R687.3[医药卫生—骨科学]