不同方式颈椎融合手术对上颈椎Jefferson骨折稳定效果的影响  

Effects of Cervical Fusion Surgery by Different Methods on Stability in Upper Cervical Spine with Jefferson Fracture

作　　者：毕厚海 赵改平[1] 许海飞 董自强 杨加静 王宏杰 BI Houhai;ZHAO Gaiping;XUHaifei;DONG Ziqiang;YANG Jiajing;WANG Hongjie(School of Medical Instrument and Food Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Shanghai 200032.China;Department of Orthopedics,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]上海理工大学医疗器械与食品学院,上海200093 [2]复旦大学附属肿瘤医院放射治疗中心,上海200032 [3]上海市第一人民医院骨科,上海200080

出　　处：《医用生物力学》2021年第2期231-237,共7页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(11502146);上海市自然科学基金项目(15ZR1429600)。

摘　　要：目的建立人体上颈椎C0~3节段Jefferson骨折有限元模型,分析后路寰枢椎融合(posterior atlantoaxial fusion,PSF)和枕颈融合(occipitocervical fusion,OCF)对颈椎椎体生物力学特性和钉棒系统力传导特性的影响。方法基于CT图像建立人体上颈椎C0~3节段Jefferson骨折模型,依据临床手术方案实施PSF、OCF1和OCF2内固定术,施加50 N集中力和1.5 N·m力矩于枕骨底部,研究上颈椎C0~3节段在前屈、后伸、侧屈和旋转运动时,颈椎椎体的应力分布和关节活动度(range of motion,ROM)、钉棒系统最大应力以及椎间盘的应力分布情况。结果OCF1和OCF2椎体ROM较PSF增加,钉棒应力减少,OCF具有较好的固定效果。结论PSF、OCF1、OCF2固定术式均可减少上颈椎ROM,重建上颈椎的稳定性,使椎体和椎间盘应力分布趋向正常水平。研究结果可为临床手术方案提供理论依据。Objective To establish the finite element model of upper cervical vertebrae C0-3 with Jefferson fracture,and to analyze the influence of posterior atlantoaxial fusion(PSF)and occipitocervical fusion(OCF)on biomechanical properties of the vertebral body and mechanical conduction of the screw-rod system.Methods Based on CT images,the C0-3 segment Jefferson fracture model of human upper cervical spine was established.PSF,OCF1 and OCF2 internal fixation were performed according to surgical plan in clinic,and 50 N concentrated force and 1.5 N·m torque were applied to bottom of the occipital bone.The stress distribution and range of motion(ROM)of the cervical vertebral body,the maximum stress of the screw-rod system and the stress distribution of the intervertebral disc for C0-3 segment during flexion,extension,bending and rotation of the upper cervical spine were studied.Results Compared with PSF,the ROM of OCF1 and OCF2 vertebral bodies increased,and the stress of the nail rod decreased.OCF had a better fixation effect.Conclusions PSF,OCF1 and OCF2 fixation method can reduce the upper cervical ROM and restore stability of the upper cervical spine,which make stress distributions of the vertebral body and intervertebral disc tend to be at normal level.The research result can provide a theoretical basis for clinical surgery plan.

关 键 词：上颈椎 JEFFERSON骨折 寰枢椎融合术 枕颈融合术 

分 类 号：R318.01[医药卫生—生物医学工程]