C2椎板螺钉短节段钉棒固定系统中交叉棒与平行棒固定的生物力学比较  

Biomechanical comparison of atlantoaxial crossed rod and parallel rod fixation technique for C2 unilateral lamina screws

作　　者：邱锋 许喜林[1] 马向阳 方周群 江伟城 田树钊 郑泽龙 Qiu Feng;Xu Xilin;Ma Xiangyang;Fang Zhouqun;Jiang Weicheng;Tian Shuzhao;Zheng Zelong(Department of Orthopedics,Puning Overseas Chinese Hospital,Puning 515300,Guangdong Province,China;Department of Spinml Surgery,Orthopaedics Hospital,Genera I Hospital of Southern Theater Comma nd,Guan gzhou 510010,Guangdong Provinee,China)

机构地区：[1]普宁华侨医院骨科,广东省普宁市515300 [2]中国人民解放军南部战区总医院骨科医院脊柱外科,广东省广州市510010

出　　处：《中国组织工程研究》2021年第12期1805-1809,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:C1双侧椎弓根螺钉联合C2椎板螺钉组成的短节段钉棒固定系统的生物力学稳定性稍显不足。目前寰枢椎后路钉棒固定通过连接棒的连接形成近似于"Ⅱ"形的固定结构,或为了增强稳定性增加横联形成近似"H"的固形结构。而交叉棒固定方式呈"X"型,由多个三角形结构构成,三角形结构的稳定性最好,有望进一步增强短节段钉棒固定系统的生物力学稳定性。目的:评价C1双侧椎弓根螺钉联合C2一侧椎板螺钉一侧椎弓根螺钉采用交叉棒固定和平行棒固定的三维生物力学稳定性。方法:6例新鲜寰枢椎脱位标本,每一例标本均置入C1双侧椎弓根螺钉及C2右侧椎板螺钉、C2左侧椎弓根螺钉。分为3组依次进行观察,不稳组不进行固定,平行棒组采用平行棒连接固定,交叉棒组采用交叉棒连接固定。分别在脊柱三维运动实验机上测量枕枢椎的三维运动范围。结果与结论:(1)在屈伸、侧屈、轴向旋转上,交叉棒组及平行棒两种内固定方式均优于不稳组(P<0.05);(2)在前屈、后伸、左侧屈、右侧屈方向上,交叉棒组稳定性与平行棒组相当(P>0.05);(3)在左旋、右旋方向上,交叉棒组稳定性大于平行棒组(P<0.05);(4)提示应用C1双侧椎弓根螺钉联合C2一侧椎板螺钉一侧椎弓根螺钉固定时,采用交叉棒方式固定可进一步增强其轴向旋转稳定性。BACKGROUND:The biomechanical stability of the screw-rod fixation system by C1 bilateral pedicle screws and C2 lamina screws was slightly insufficient.Posterior atlantoaxial fixation with screw-rod forms an approximate"II"shape or"H"increasing transverse-link for better stability.Crossed rod,constituted by connecting rods to the contralateral screws,forms an approximate"X"shape.This fixed construct just likes multi-triangles,whose stability is best,may further enhance the stability.OBJECTIVE:To evaluate the three-dimensional biomechanical stability of the fixation technique for the crossed rod and parallel rod by the C1 bilateral pedicle screws combined with C2 one pedicle screw and the other lamina screw.METHODS:Six fresh adult craniocervical specimens were used to test the biomechanical stability.All the specimens were fixed using C1 bilateral pedicle screws and C2 left pedicle screw and right lamina screw.The specimens were observed sequentially in three groups.The unstable group was not fixed.The parallel rod group was fixed by parallel rod connection.The crossed rod group was fixed by the crossed bar connection.The three-dimensional range of motion of the occipital axis was measured on a three-dimensional spinal motion testing machine.RESULTS AND CONCLUSION:(1)The two internal fixation methods were better in the crossed rod and parallel rod groups than in the unstable group on flexionextension,lateral bending and left and right axial rotation(P<0.05).(2)The stability of the crossed rod group was equal to that of the parallel rod group on flexion-extension and lateral bending(P>0.05).(3)The stability of the crossed rod group was better than that in the parallel rod group on left and right axial rotation(P<0.05).(4)When the fixation with C1 bilateral pedicle screws and one C2 pedicle screw and the other lamina screw is used,crossed rod fixation can further enhance the axial rotation stability.

关 键 词：骨 寰枢椎 寰枢椎不稳 内固定 交叉棒 平行棒 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]