枕颈区后路柔性动态固定的生物力学研究  

Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region

作　　者：童杰[1,2] 季伟 黄志平[1] 周若舟[1,2] 房佐忠[2] 朱青安 Tong Jie;Ji Wei;Huang Zhiping;Zhou Ruozhou;Fang Zuozhong;Zhu Qingan(Department of Spinal Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Spine Surgery,Affiliated Chenzhou Hospital,The First School of Clinical Medicine,Southern Medical University(The First People’s Hospital of Chenzhou),Chenzhou 423000,China)

机构地区：[1]南方医科大学南方医院脊柱骨科,广州510515 [2]南方医科大学第一临床医学院附属郴州医院(郴州市第一人民医院)脊柱外科,湖南郴州423000

出　　处：《中国临床解剖学杂志》2022年第3期315-319,326,共6页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金面上项目(81972110);郴州市科学技术局科技发展计划项目(ZDYF2020015);郴州市第一人民医院科研项目(N2019-008);郴州市第一人民医院院内技术项目(2020A34);湘南学院科研项目(2020XJ134)。

摘　　要：目的探讨柔性和动态固定方式对枕颈区稳定性的影响。方法采用6具新鲜成人枕颈区Oc~C_(4)节段进行测试,模拟以下状态:(1)完整状态;(2)损伤状态:齿状突Ⅱ型骨折加寰枕关节囊损伤;(3)坚强固定:C_(1)、C_(2)用普通椎弓根螺钉固定,C_(3)侧块螺钉,直径3.5 mm钛棒连接;(4)柔性固定:直径2.0 mm钛棒连接;(5)C_(1)用2枚转动钉固定;(6)C_(1)、C_(2)用4枚转动钉固定;(7)C_(1)、C_(2)、C_(3)用6枚转动钉固定。通过脊柱试验机对标本施加1.5 Nm的纯力偶矩,三维运动测量系统分析枕颈区Oc~C_(3)角度运动范围和中性区。结果直径2.0 mm的棒固定后的运动范围,在各个方向上均大于坚强固定,有显著性差异(P<0.05)。与坚强固定比较,在C_(1)、C_(2)采用2~4枚转动钉固定,在各方向上运动范围相当(P>0.05)。C_(1)、C_(2)、C_(3)使用6枚转动钉固定仅在旋转方向上明显增加了Oc~C_(3)运动范围,差别有统计学意义(P=0.031)。不同固定方式在屈伸、侧弯和旋转方向上均显著减小了固定节段的中性区(P<0.05)。结论枕颈区Oc~C_(3)节段,采用直径2.0 mm的细棒固定,各方向的稳定性均弱于坚强固定。在C_(1)、C_(2)采用2~4枚转动钉固定,与坚强固定的稳定性相当。在C_(1)、C_(2)、C_(3)采用6枚转动钉固定,仅在旋转方向上弱于坚强固定。Objective To analyze the effects of flexible and dynamic fixation on the stability of the occipitocervical region.Methods Biomechanical tests were performed by using six fresh adult cervical spines(occipital bone-C_(4)segment,Oc~C_(4)),with the fixation site extended from the occipital bone to the C_(3)vertebra.The following conditions were stimulated:(1)Intact state;(2)Injury state:a combination of type II odontoid fractures and atlanto-occipital capsule injury;(3)Rigid fixation:a 3.5 mm diameter titanium rod was used to connect C_(3)lateral mass screws,C_(1),and C_(2)were fixed with common pedicle screws;(4)Flexible fixation:a 2.0 mm diameter titanium rod was used to fix Oc~C_(3)with locking connections between the screws and rods;(5)Fixation by using two rotating pedicle screws;(6)C_(1)and C_(2)were fixed with four rotating pedicle screws;(7)C_(1),C_(2) andC_(3)were fixed with six rotating pedicle screws.Biomechanical studies were performed by using a spinal testing machine,while applying a constant moment of 1.5 Nm in flexion-extension,left-right lateral bending,and left-right axial rotation directions were measured to analyze the range of motion(ROM)and neutral zone(NZ)of Oc~C_(3)segments.Results ROM of 2.0mm diameter rod fixation was significantly larger than that of rigid fixation in all directions(P<0.05).Compared with the rigid fixation,ROM of Oc~C_(3)in C_(1)and C_(2)with a fixation that used 2~4 rotating pedicle screws was similar in all directions(P>0.05).The application of six rotating pedicle screws in C_(1)~C_(3)significantly increased ROM for rotation in Oc~C_(3)with statistical significance(P=0.031).Different fixation methods significantly reduced the neutral zone of fixed segment in flexion,extension,lateral bending and rotation directions(P<0.05).Conclusions In the occipital cervical region Oc~C_(3),the stability of all directions with using flexible fixation was weaker than that of rigid fixation.In the occipital cervical region,the stability of using two or four rotating screw fixations in C_

关 键 词：寰椎 枢椎 枕颈区 柔性固定 动态固定 稳定性 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]